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RA790  W58  1 91 7    The  principles  of  me 


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THE  PRINCIPLES 

OF 

MENTAL  HYGIENE 


THE  MACMILLAN  COMPANY 

HEW  YORK  •    BOSTON   •    CHICAGO  •    DALLAS 
ATLANTA   •    SAN   FRANCISCO 

MACMILLAN  &  CO.,  Limited 

LONDON   •    BOMBAY  •    CALCUTTA 
MELBOURNE 

THE  MACMILLAN  CO.  OF  CANADA,  Ltd. 

TORONTO 


THE  PRINCIPLES 

OF 

MENTAL  HYGIENE 


BY 

WILLIAM  A.  WHITE,  M.D. 


WITH  AN  INTRODUCTION  BY 
SMITH  ELY  JELLIFFE,  M.D.,  Ph.D. 


N^m  fork 

THE  MACMILLAN  COMPANY 

1917 

All  rights  reserved 


Copyright  1917 
bt  the  MACMILLAN  COMPAKY 


Set  up  and  electrotyped.    Published  November,  1917. 


c^^&^^ 


PREFACE 

For  many  years  a  small  group  of  philanthropic- 
ally  minded  persons  have  been  fighting  the  battles 
of  the  failures  in  life  and  trying  to  secure  for  them 
an  adequate  understanding  which  should  be  the 
basis  for  creating  a  new,  a  more  enlightened,  and  a 
constructive  and  helpful  program  for  dealing  with 
them.  Despite  the  length  of  time  this  movement  in 
its  various  ramifications  has  been  in  existence,  and 
the  number  of  people  who  have  been  engaged 
in  it,  and,  too,  the  high  type  of  many  so  engaged, 
there  never  has  issued  from  its  sponsors  anything 
that  could  properly  be  called  a  comprehensive  pro- 
gram, an  adequate  statement  of  principles  scien- 
tifically founded  and  practically  workable.  The 
reason  for  this  seems  to  me  clear.  These  persons 
had  no  such  program,  they  had  no  such  princi- 
ples, their  moving  force  was  faith. 

Many,  perhaps  all,  great  movements,  are  thus 
shadowed  forth  in  their  origins  by  the  faith  that  is  in 
those  who  believe  in  them.  It  is  these  pioneers  to 
whom  all  honour  is  due,  who  have  had  the  courage 
to  speak  for  what  they  believed  was  right,  for  what 
they  had  faith  in,  in  the  face  of  opposition  and 
ridicule  and  even  though  when  asked  to  state  their 
v^      case  they  found  themselves  quite  incapable  of  put- 


vi  PKBFACE 

ting  into  words  what  they  felt.  They  have  stood 
firm,  however,  until  principles  could  be  formulated 
and  programs  projected.  When  that  day  arrived 
the  battle  was  perhaps  already  won. 

The  battle  for  mental  hygiene  has  already  been 
won.'  The  far  seeing  faith  of  its  progenitors  felt 
and  knew  that  a  way  could  always  be  found  to  solve 
any  problem  that  needed  to  be  solved,  if  only  there 
was  the  patience  to  keep  on,  the  determination  to 
succeed.  Mental  hygiene  has  come  to  stay,  there  is 
not  the  shadow  of  a  doubt  about  that,  but  its  prin- 
ciples remain  to  be  formulated  because  its  activities 
have  been  scattered  over  so  many  fields  which,  while 
not  really,  still  are  practically,  disconnected.  There 
have  been  the  problems  of  the  care  of  the  insane, 
prison  reform,  pauperism,  alcoholism,  feeble-mind- 
edness,  juvenile  delinquency,  atypical  children, 
vagrancy,  prostitution,  vocational  education,  the 
neuroses  and  psychoneuroses,  drug  addiction,  social 
hygiene  (venereal  prophylaxis),  patent  medicines 
and  faith  cures,  and  many  others,  all  of  which  have 
been  recognized  by  some  as  being  problems  that 
would  have  to  be  attacked  more  or  less  exclusively 
by  methods  founded  in  the  principles  of  a  hygiene 
of  mind. 

The  various  directions  in  which  these  problems 
have  arisen  has  tended  to  a  somewhat  mutual  ex- 
clusiveness  so  that  each  group  was  interested  only 
in  some  particular  aspect  of  the  larger  problem. 
The  whole  field  has,  therefore,  not  as  yet  been  com- 
prehensively surveyed.    To  do  this  in  an  at  all  ade- 


PEEFACE  vii 

quate  manner  would  be  a  large  undertaking,  per- 
haps too  large  to  be  dealt  with  in  a  single  volume. 
It  will  be  my  object  in  this  book  to  sketch  the  out- 
line, stressing  the  larger  problems,  and  completing 
the  statement  by  a  briefer  filling  in  of  details.  Such 
matters  as  the  principles  involved  in  the  concepts 
of  the  great  defective,  delinquent,  and  dependent 
groups,  the  significance  of  the  insane,  the  criminal, 
and  the  feeble-minded  classes,  of  the  principles  of 
society's  relation  to  them  will  receive  the  larger 
amount  of  attention,  while  such  questions  as  divorce, 
the  woman  movement,  etc.,  will  come  in  for  small 
mention,  not  because  they  are  of  less  importance  for 
perhaps  they  are  not,  but  because  it  would  seem  that 
the  great  guiding  principles  can  be  seen  plainer  in 
these  other  problems  for  there  we  can  see  the  springs 
of  human  conduct  laid  bare,  less  overlaid  with  the 
disguises  of  a  conventional  society.  These  questions 
will  be  discussed,  however,  not  with  the  purpose  of 
attempting  to  solve  them  but  because  they  are  pres- 
ent-day examples  of  bad  mental  hygiene,  that  is, 
they  show  in  action  those  factors  at  work  which  in- 
terfere most  seriously  with  an  efficient  handling  of  a 
situation — such  as  prejudice,  hate,  etc.,  and  so  come 
within  the  realm  of  mental  hygiene  indirectly,  al- 
though their  problems,  as  such,  might  hardly  be  con- 
ceived to  belong  there. 

In  accordance  with  this  program  the  book  will 
naturally  fall  into  two  parts.  The  first  part,  com- 
prising the  Introduction  and  Chapter  I,  will  be 
theoretical,  a  laying  down  of  fundamental,  scientific 


viii  PREFACE 

principles,  and  can  well  be  omitted  by  the  prac- 
tical worker  whose  interests  are  not  primarily  scien- 
tific or  philosophical.  The  second  part  will  take  up 
the  larger  issues,  such  as  the  insane,  the  criminal, 
etc.,  and  progress  to  the  less  well  defined  and  less 
distinctly  pathological  problems.  The  summary 
will  attempt  to  bring  all  the  issues,  theoretical  and 
practical  together  and  will  thus  require  a  knowledge 
of  both  parts  of  the  book. 


INTEODUCTION 

To  have  accomplished  the  task  of  a  practical  un- 
derstanding of  the  changes  which  accompany  the  dis- 
orders of  the  bodily  organs  may  be  said  to  have 
been  the  crowning  achievement  of  the  medicine  of 
the  nineteenth  century.  It  is  now  only  a  question 
of  time  when  such  knowledge  shall  be  put  into  effec- 
tive relationship  with  social  activities  and  much  of 
what  we  have  hitherto  been  terming  disease  will 
gradually  cease  to  have  the  power  of  compelling 
fear  and  dread.  For  disease  will  no  longer  be 
looked  upon  as  a  single  manifestation,  or  a  group 
of  such  manifestations,  to  be  attacked  as  separate 
entities,  with  a  futile  lack  of  understanding  of  causes 
and  of  these  same  relationships.  The  whole  effect 
of  disease  upon  the  social  body,  and  its  origins  as 
expressions  of  an  interrelationship  with  this,  will 
be  considered  an  indispensable  feature  of  its  under- 
standing and  effective  handling. 

It  is  a  fundamental  position  taken  in  this  book, 
and  one  which  will  undoubtedly  come  to  be  univer- 
sally held  before  a  final  conquest  of  disease  will  have 
been  accomplished,  that  disease  after  all  is  maladap- 
tation  of  function  of  the  entire  body  in  all  of  its  re- 
lations, and  that  no  hard  and  fast  line  separates  the 
functions  of  any  organ  of  the  body  into  physical  and 
mental,  nor  limits  the  disease  concept  to  exclude  mal- 


X  INTRODUCTION 

adaptation  in  the  social  any  more  than  in  the  indi- 
vidual functioning  of  the  entire  organism.  The 
term  physical  still  lingers  in  our  mental  fabric,  how- 
ever, and  threatens  by  a  too  great  conservatism  of 
habit  to  obstruct  the  larger  point  of  view  which  this 
valuable  work  seeks  to  point  out. 

Mens  Sana  in  corpore  sano, — a  healthy  mind  in  a 
healthy  body — has  been  the  watchword  of  past  civi- 
lizations. It  is  time  to  modify  this  and  to  recognize 
that  this  is  but  one-half  of  a  truth,  which  in  order  to 
be  realized  needs  to  be  stated  in  a  larger  form  which 
embraces  this.  Corpus  sanum  in  mente  sana, — a 
healthy  body  can  only  exist  as  its  behaviour  is  influ- 
enced and  controlled  by  a  healthy  mind.  For  it  is 
becoming  more  and  more  evident  that  what  we  call 
mind  is  an  organized  principle  in  evolution  with  a 
structure  just  as  real  as  any  organ  of  the  body,  not 
a  distinct  static  thing  of  material  form  and  dimen- 
sions, but  a  no  less  distinctive  working  entity,  a 
product  of  evolutionary  growth  and  a  grouping  of 
functional  activities,  the  chief  distinguishing  feature 
between  mind  structure  and  organ  structure  being 
the  greater  plasticity  of  the  functional  capacity  of 
the  former  for  the  utilization  of  the  stores  of  energy 
which  surround  us  and  force  us  into  action. 

One  might  say  that  when  living  matter  in  higher 
animals  had  more  or  less  completely  solved  the 
problem  of  how  to  utilize  the  energy  of  the  chemical 
substances  which  we  roughly  symbolize  as  sugars, 
for  example,  then  this  function,  more  or  less  com- 
pletely learned,  became  structuralized  into  what  we 


INTRODUCTION  xi 

call,  let  us  say,  tlie  liver.  Liver  structure  becomes 
thus  more  or  less  finished,  this  metabolism  of  sugar 
has  been  learned,  for  the  most  part  the  work  of 
energy  transformation  goes  on  automatically,  only 
hindered  when  other  organs,  functioning  imper- 
fectly, refuse,  as  it  were,  to  let  it  perform  its  own 
task  unmolested. 

Now  the  mind  structuralizations  are  still  open, 
still  formulating,  for  social  adaptations  have  not 
been  so  completely  individualized  as  chemical 
adaptations.  Many  have  been  structuralized  for 
the  time  being  in  wise  precepts.  Golden  Rules, 
in  the  Talmud,  Eig  Veda,  laws  of  the  Twelve 
Tables  or  the  whole  group  of  gradually  shift- 
ing codes  contained  in  the  Bible.  Such  literary 
crystallizations,  which  represent  great  planes  in  the 
development  of  thought  and  language,  as  those  of 
Shakespeare  or  Goethe,  constitute  likewise  the 
slowly  deposited  and  slowly  changing  forms  and 
grades  of  this  same  structuralizing  process,  as  do 
also  international  agreements,  world  customs,  etc., 
etc.  But  so  long  as  time  is  continually  progressing, 
new  possibilities  for  better  and  better  adaptations 
are  left  open,  which  by  reason  of  the  plasticity  of  the 
mental  structures,  are  continually  taking  place. 

Thus  ever  higher  attributes  of  social  evolution  are 
possible  and  since  it  is  so,  it  is  incumbent  upon 
human  society  to  discover  and  attain  to  them.  The 
realization  of  them,  according  to  the  progressing 
measure  of  social  capacity,  means  health.  Failure 
to  attain,  or  disorder  in  the  social  system  which  in- 


xii  INTRODUCTION 

terferes  with  such  progressive  functioning,  ex- 
presses the  various  inadequacies  and  disabilities  of 
society,  its  lack  of  perfect  health  and  healthy  activ- 
ity. These  are  the  various  phenomena  which  are  so 
ably  discussed  in  this  treatise.  Whether  physicians 
term  them  diseases  of  the  spirit,  or  of  the  soul,  or  of 
the  mind  in  its  collective  function,  is  innnaterial. 
The  important  fact  to  recognize  is  that  of  their  ori- 
gins, for  only  by  an  understanding  of  how  such 
things  come  to  pass  can  they  be  alleviated  and  thus 
human  happiness  made  more  possible. 

This  work  will  materially  further  such  a  compre- 
hension of  the  various  grades  of  certain  types  of 
failure  and  their  underlying  causes,  and  thus  prove  a 
constructive  agency  for  their  diminution  or  removal. 
Thus  we  shall  arrive  at  a  true  ideal  formulation  of  a 
healthy  society,  which  means  also  in  the  individual- 
society  relationship,  upon  which  this  discussion  is 
based,  a  healthy  individual  and  therefore  a  healthy 
body.  In  such  an  ideal  society  it  will  be  seen,  for 
instance,  that  such  a  physical  disease  as  typhoid 
fever  cannot  exist,  for  it  must  in  reality  be  consid- 
ered a  disease  due  to  an  imperfect  society.  The  per- 
sistence of  typhoid  fever  in  a  coromunity  is  a  symbol, 
not  alone  of  the  ignorance  of  that  society,  but  a  sign 
of  the  inertness,  of  the  cupidity  and  self-seeking  of 
the  majority,  who  consider  their  individual  comforts 
and  personal  satisfactions  ahead  of  those  of  their 
fellow  men.  They  refuse,  by  their  maintenance  of 
corrupt,  inadequate  political  machinery  of  well 
acknowledged   incompetency,   to   put   to   work   the 


INTRODUCTION  xiii 

proper  agencies  to  eliminate  typhoid  fever  from  the 
map.  This  is  merely  another  way  of  saying  that  the 
individual  in  the  large,  in  his  social  relationship,  is 
still  spiritually  ill.  His  mental  vision  cannot  yet 
take  in  the  larger  whole,  which  were  he  able  or  will- 
ing to  see,  would  keep  his  body  well,  because  his 
social,  mental  function,  that  is  his  soul,  would  have 
grown  up  and  formed  a  structurally  effective  mental 
hygiene.  Since  moreover  the  practical  purposes  of 
a  cultural  civilization,  built  to  express  and  fulfil 
man's  greater  needs,  have  indissolubly  bound  indi- 
vidual and  the  society,  environment,  to  which  he  be- 
belongs,  this  limitation  of  a  larger  vision  which 
means  the  individual  illness  makes  society  also  ill 
and  imperfect  and  deficient  in  its  functioning.  Thus 
while  ignorance,  timidity,  incompetency  denote  the 
illness  of  the  individual  members  of  society,  it  is 
equally  true  that  an  ineffectual,  incomplete,  inade- 
quate attitude  towards  social  skeletons  is  sympto- 
matic of  the  iUness  of  society. 

The  new  century  of  medicine  may  well  be  char- 
acterized as  that  of  discovery  and  investigation  of 
causes  and  interrelationships.  The  keen  analysis 
which  searches  out  individual  causations  and  probes 
to  the  uttermost  each  separate  phenomenon  of  form 
or  function,  must  be  followed  by  a  comprehensive 
synthesis,  in  which  interdependence  of  form  and 
mutual  modification  of  function  are  sought  to  be  un- 
derstood both  in  their  causes  and  in  their  effects  for 
individual  and  society.  Both  analysis  and  syn- 
thesis, in  this  their  pragmatic  significance,  are  gen- 


xiv  INTRODUCTION 

etically  considered,  since  cause  and  effect  are  to  be 
understood  as  evidences  of  the  energj^  which  infuses 
life,  as  it  is  transmuted  and  transposed  to  create  and 
to  activate  the  lesser  structuralizations  of  material 
organs  and  forms,  or  more  progressively  still,  the 
higher  structuralizations  of  mind,  which  are  here 
discussed  principally  in  their  social  forms,  the  high- 
est expressions  of  psychological  activity. 

Thus  it  is  that  individual  health  and  social  health 
are  interdependent.  The  sound  body  in  the  well- 
regulated  mind,  free  and  open  in  its  conductivity  of 
the  informing  energy,  is  both  the  proof  of  such  a 
creative,  active  force,  and  its  means  of  expression. 
Equally  will  a  sound  social  body  be  created  only  out 
of  such  a  free  and  unhindered  social  mind,  the  col- 
lective consciousness,  whatever  it  may  be  called. 
The  healthy  body  of  the  individual  and  the  healthy 
activity  of  society  depend  therefore  upon  just  such 
a  penetrating  knowledge  of  those  elements  of  indi- 
vidual psychology  and  of  its  social  forms  as  this 
book  has  brought  to  attention ;  and  upon  such  a  syn- 
thesis of  these  factors,  which  reveals  their  necessary 
interrelationships,  the  disharmony  resulting  when 
these  are  interfered  with  or  overlooked  and  the 
harmony  and  progress  when  they  are  logically  taken 
into  account. 

Smith  Ely  Jelliffe. 


CONTENTS 

PAGE 

Preface v 

Introduction  by  Dr.  Smith  Ely  Jellippe     .      ix 

CHAPTER 

I    Introduction 1 

II    Underlying  Concepts 11 

III  Mental  Mechanisms 34 

The  unconscious,  34;  The  instinct  for  the  familiar 
— the  safety  motive,  38;  The  path  of  opposites — 
love  and  hate,  44;  Projection — the  antipathic  emo- 
tions, 46;  Antagonism — identification,  51;  Conversion, 
53;  Other  defence  mechanisms,  56. 

IV  The  Insane 60 

The  word  insane,  60;  Historical,  66;  The  ideal  of 
knowledge,  76;  The  conflict,  84;  The  hospital,  89;  The 
agencies,  92;  The  means,  94;  The  methods,  101;  Siim- 
mary,  116. 

V    The  Criminal 118 

The  concept  criminal,  118;  The  nature  of  criminal 
conduct,  120;  The  results,  129;  The  criminal  as  scape- 
goat, 131;  The  remedy,  136;  Summary,  156. 

VI    The   Fbeble-Minded 159 

Tlie  concept  feeble-mindedness,  166;  The  eugenic 
solution,  170;  The  menace  of  feeble-mindedness,  180; 
What  is  to  be  done  about  it?  185. 


CONTENTS 

CHAPTEE  PAGE 

VII    Miscellaneous  Groups 192 

The  pauper,  192;  The  prostitute,  195;  The  inebriate, 
201;  The  epileptic,  206;  The  homosexual,  208;  The 
vagrant,  211;  The  homeless  unemployed,  212. 

VIII    Miscellaneous  Problems 215 

Patent  medicines — "cures,"  215;  Fatigue,  225; 
Divorce,  231;  The  woman  movement,  237;  Free 
speech,  239;  Illegitimacy,  243;  Social  hygiene,  245; 
Dangerous  occupations,  247;  Vocational  psychology, 
249;  Fads,  250;  Wealth,  253;  Idleness,  255;  Old  age 
—death,  258. 

IX    The  Neuroses — ^Psychoanalysis     .     .     .     •  263 

Character  anomalies,  267;  Character  traits,  270; 
Socialization  of  instincts,  273;  Animism,  283;  The 
organic  basis  of  maladjustment,  284;  Psychoanalysis, 

288. 

X    Summary 30} 


THE  PRINCIPLES  OF  MENTAL 
HYGIENE 

CHAPTEE  I 
INTRODUCTION 

Hygeia,  the  goddess  of  health,  was  very  appropri- 
ately the  daughter  of  ^sculapius,  the  god  of  medi- 
cine. It  is  fitting,  both  that  she  should  have  come 
after,  and  that  she  should  have  been  related  to  the 
god  of  medicine.  Hygiene,  by  carrying  forward  the 
principles  learned  in  combatting  disease,  comes  to 
embody  the  ideal  of  medical  practice  and  its  latest 
development,  preventive  medicine.  If  preventive 
medicine  had  a  goddess  it  would  probably  be  re- 
corded that  she  was  the  daughter  of  Hygeia  and 
that  she  was  born  about  the  middle  of  the  nineteenth 
century. 

The  earliest  manifestations,  of  what  grew  to  be- 
come preventive  medicine,  were  along  the  simpler 
developments  of  sanitation.  They  came  into  being 
in  the  cities  probably  largely  as  a  result  of  the  con- 
gestion of  the  population  in  these  centres  due  to  the 
growth  of  the  factory  as  an  industrial  institution. 
The  crowding  of  large  numbers  of  poor  labourers 
together  in  the  big  cities  under  unsanitary  condi- 


2  MENTAL  HYGIENE 

tions  of  employment,  of  housing,  and  of  living  gen- 
erally came  to  be  appreciated  as  a  menace  to  the 
health  of  the  city.  Out  of  such  situations  grew  the 
general  principles  of  sanitation  directed  to  the  re- 
moval of  obvious  filth,  principles  of  sewage  disposal, 
water  supply,  etc.  This  development  dealt  only 
with  the  most  obvious  defects,  its  vision  was  very 
narrow,  comprising  only  the  immediate  interests 
without  any  vision  for  the  future  or  the  wider  possi- 
bilities, and  requiring  little  more  than  police  author- 
ity, and  not  expert  knowledge  and  experience,  to 
carry  out.^ 

From  these  simple  beginnings  development  pro- 
ceeded rapidly  along  lines,  not  only  calculated  to 
remove  the  most  serious  immediate  dangers  to  life 
and  health,  but,  going  along  hand  in  hand  with  social 
reform  movements,  tended  to  a  general  improve- 
ment of  the  environment,  such  as  well-paved  streets, 
the  creation  of  the  great  public  utilities,  and  in  gen- 
eral fostering  those  developments  that  made  life  de- 
cidedly more  worth  living. 

The  most  definite  advances  along  the  combined 
lines  of  social  reform  and  public  sanitation  grew  up 
in  connection  with  the  great  industrial  renaissance 
incident  to  the  supplementing  and  replacing  of  the 
methods  of  the  old  handicrafts  by  the  use  of  ma- 
chinery and  the  congregation  of  labour  in  large  com- 
munities by  the  development  of  the  factory  system. 

1  For  a  short  historical  summary  of  the  growth  of  sanitation,  etc., 
see  Havelock  Ellis:  "The  Task  of  Social  Hygiene."  Houghton  Mif- 
flin Co.,  1915. 


INTEODUCTION  3 

This  concentration  of  poorly  paid  and  poorly  housed 
factory  hands  led  to  conditions  which  obviously 
were  unsanitary,  and  methods  of  sanitation  were 
evolved  to  meet  them  and  were  enacted  into  statutes 
and  adequate  police  authority  provided  for  to  en- 
force them. 

The  social  developments  which  have  grown  out  of 
the  attempts  to  correct  the  evil  influences  of  the 
modern  industrial  system  are  extremely  interesting 
and  instructive  to  follow  in  their  development  for 
they  represent  on  a  small  scale  the  principles  in- 
volved in  the  larger  issues,  some  of  which  it  will  be 
the  object  of  this  book  to  discuss. 

A  tendency  cropped  out  quite  early  in  the  history 
of  the  industrial  revolution  to  see  the  problems 
from  a  somewhat  wider  angle  and  to  realize  that 
the  end  and  aim  of  the  reform  movements  and  the 
objects  of  sanitation  could  not  be  solely  the  protec- 
tion of  one  social  group  against  the  nuisances  cre- 
ated by  another.  The  interrelations  and  interde- 
pendencies  of  the  two  groups,  that  is,  the  labouring 
classes  on  the  one  hand  and  the  rest  of  the  people 
on  the  other,  were  early  appreciated  by  a  few  ad- 
vanced thinkers  and  indeed  we  find  practical  expres- 
sion of  this  recognition  on  a  large  scale  in  the  begin- 
ning of  the  nineteenth  century  in  the  initiation,  near 
Glasgow,  by  Robert  Owen,  of  what  has  come  to  be 
known  as  factory  welfare  work.^  He  built  up  a 
model  village,  improved  the  housing  facilities,  pro- 

2  See  "Principles  of  Industrial  Organization,"  by  Dexter  S.  Kim- 
ball.    The   McGraw-Hill   Book  Co.,   New  York,    1913, 


4  MENTAL  HYGIENE 

vided  means  for  recreation,  schools,  library,  de- 
vised special  purchasing  methods  to  the  advantage 
of  the  workman,  undertook  the  elimination  of  drunk- 
enness and  reduced  the  hours  of  labour  from  thir- 
teen and  fourteen,  or  even  sixteen  in  some  instances, 
to  ten. 

From  these  early  beginnings  the  movement  has 
continued  which  has  as  its  object  to  surround  the 
worker  with  better  conditions  both  in  his  work  and 
in  his  living,  which  is  based  first  upon  a  feeling  of 
duty,  and  thus  has  come  to  be  understood  as  desir- 
able and  which  has  fijially  been  demanded  by  the 
worker  himself  as  a  right. 

Legislation  and  practice  have  developed  from  the 
crude  beginnings  based  on  a  desire  to  be  rid  of 
obviously  unsanitary  and  disorderly  conditions,  be- 
cause of  their  manifest  dangers,  to  the  provision  of 
wholesome  working  and  living  conditions,  includ- 
ing reasonable  hours  of  work  and  adequate  compen- 
sation, to  still  further  and  more  extensive  provision 
for  the  welfare  of  the  worker  by  giving  opportuni- 
ties to  acquire  an  industrial  education  which  will  fit 
him  for  the  better  skilled  positions.  The  future  is 
still  further  provided  for  by  vocational  training  in 
the  public  schools,  by  workmen's  liability  and  in- 
surance acts,  and  old  age  pensions.  In  another 
direction  similar  ends  are  sought  by  providing  ade- 
quate relief  from  work,  with  full  pay,  of  women  just 
before  and  after  confinement  and  legislation  con- 
trolling their  hours  of  duty  and  limiting,  prohibit- 
ing, or  prescribing  the  conditions  of  child  labour. 


INTRODUCTION  5 

Along  with  all  of  these  developments  have  grown 
up  a  body  of  laws  which  have  invaded  more  and 
more  the  region  that  used  to  be  thought  of  as  be- 
longing absolutely  to  the  individual,  and  which  have 
sought  to  regulate  his  conduct  in  divers  ways  sup- 
posedly calculated  for  his  own  welfare  and  for  the 
welfare  of  the  group.  For  example :  He  must  see 
that  his  children  go  to  school  for  a  certain  minimum 
period:  he  must  pay  taxes  for  the  support  of  pub- 
lic schools,  even  though  he  send  his  own  children 
to  private  ones:  he  is  prohibited  from  using  al- 
coholic liquors  except  under  certain  prescribed  con- 
ditions, or  he  may  in  fact  be  prohibited  from  using 
them  altogether :  if  he  wishes  to  build  a  house  or  a 
factory  there  are  the  building  regulations  to  be  com- 
plied with:  if  it  is  a  factory  that  he  has  built  and 
is  operating  then  he  may  not  permit  dense  black 
smoke  to  issue  from  its  stacks  beyond  certain  limits 
of  time  and  frequency :  if  he  is  an  employer  he  must 
make  certain  prescribed  sanitary  and  hygienic  pro- 
visions for  his  employes,  while  under  certain  condi- 
tions he  is  held  responsible  if  they  acquire  disease 
or  are  injured  while  working  for  him.  In  these,  and 
in  many  other  ways,  the  State  reaches  into  the 
private  affairs  of  its  citizens  and  seeks  to  regulate 
them  for  the  common  good. 

The  more  definitely  public  health  developments 
have  been  of  like  character.  Disease  has  been 
sought  out  with  ever  increasing  accuracy  and  suc- 
cess, a  large  number  are  reportable  under  penalty, 
quarantine  regulations   have  been  perfected   and 


6  MENTAL  HYGIENE 

made  enforceable  by  police  authority,  while  such 
preventive  measures  as  vaccination  are  made  com- 
pulsory and  many  others  are  provided,  often  for  the 
asking.  The  welfare  of  the  individual  and  the  com- 
munity have  both  received  consideration,  while  in 
such  measures  as  the  sanitary  rehabilitation  of  a 
community  following  an  epidemic,  such  as  typhoid, 
we  see  some  of  the  best  of  public  health  efforts  cal- 
culated to  afford  protection,  not  only  now  but  to 
carry  the  protection  forward  indefinitely. 

Such  are  some  of  the  activities  directed  first  to 
affording  protection  from  an  obvious,  a  present  and 
an  acute  danger  and  developing  finally  into  meas- 
ures, the  effects  of  which  will  only  accrue  in  succeed- 
ing generations,  but  which  are  calculated  to  make 
for  better  health,  greater  efficiency,  and  greater 
safety  from  disease  and  injury.  In  other  words, 
they  are  methods  which  are  directed,  almost  ex- 
clusively, to  improving  living  conditions,  that  is,  the 
environment. 

That  improvements  in  living,  that  greater  com- 
forts, more  happiness  could  be  attained  solely  by  an 
approach  to  the  problems  from  without  has  always 
seemed  the  natural  way  of  looking  at  the  situation. 
That  the  problem  should  be  approached  from 
within  has  never  seemed  to  challenge  the  attention, 
of  course  with  certain  notable,  mostly  individual  ex- 
ceptions. 

The  reason  for  this  failure  to  look  within  is  rather 
difficult  to  assign.  It  seems  quite  evident  that  if 
satisfactory  living  is  an  expression  of  the  relation 


INTRODUCTION  7 

individual-environment,  then  not  only  the  environ- 
ment but  the  individual  must  be  looked  to  for  re- 
sults. True,  the  individual  has  been  looked  to  but 
only  as  constituting  part  of  the  environment.  A 
person  sick  with  a  contagious  disease  is  so  much 
dangerous  environment  so  far  as  the  rest  of  the 
community  is  concerned.  Only  in  this  way,  as  en- 
vironment, has  the  individual  been  at  all  adequately 
dealt  with. 

To  approach  the  problem  from  within  means 
something  very  different  from  this.  This  is  essen- 
tially a  matter  of  mind,  of  psychology,  and  means 
that  the  individual  must  regard  himself  in  the  re- 
lation indivdual-environment,  and  seek  to  deter- 
mine what  are  the  elements  of  that  relation  which 
are  under  his  control,  what  he  is  giving  to  the  situa- 
tion, how  he  can  change  himself  so  as  to  change  the 
relation  to  his  advantage. 

That  this  movement  to  develop  a  mental  hygiene 
has  arisen  only  after  all  other  kinds  of  hygiene  have 
been  advanced  to  a  pretty  high  grade  of  efficiency  is 
due  to  many  causes.  In  the  first  place  it  is  perhaps 
to  no  small  extent  the  usual  result  of  the  tendency 
to  overlook  the  obvious.  The  one  particular  thing 
that  we  are  least  apt  to  regard  as  at  fault  when  we 
get  into  trouble  is  ourselves,  that  is,  our  moral,  per- 
sonal selves,  not  so  much  our  bodily  selves,  this  for 
reasons  which  will  come  up  for  more  careful  exam- 
ination later.  We  may  rest  here  with  the  assump- 
tion that  it  is  an  instance  of  failure  to  see  the  obvi- 
ous, to  overlook  the  thing  nearest  at  hand. 


8  MENTAL  HYGIENE 

Perhaps  the  most  important  reason,  however,  is 
dependent  upon  the  really  enormous  complexity  of 
the  problems.  The  tremendous  complexity  of  the 
human  organism,  which  has  baffled  man's  reason 
for  so  many  generations,  is  only  beginning  to  be 
sufficiently  fathomed  so  that  a  comprehensive  grasp 
of  the  entire  problem  is  coming  to  be  within  the 
bounds  of  possibility,  and  it  is  only  when  such  a 
comprehensive  grasp  is  possible  that  the  phenomena 
of  mind  fall  into  place  for  consideration  at  all,  for 
they  deal  with  the  organism  as  a  whole  and  there- 
fore it  is  only  after  its  separate  parts  in  their  in- 
terrelations and  interdependencies  have  been  un- 
derstood that  the  problem  of  the  whole  can  be  ap- 
proached. 

As  soon  as  we  come  to  an  appreciation  of  this  way 
of  looking  at  man  we  come  also  to  see  that  there  is  a 
psychological  aspect  to  many  a  situation  that  we 
had  before  looked  at  exclusively  from  some  other 
angle.  This  whole  matter  will  be  more  fully  dis- 
cussed later  but,  in  order  to  illustrate  this  thesis  I 
will  undertake  to  defend  it  briefly  in  a  simple  case. 

Why,  for  example,  does  a  person  who  is  suffering 
the  pain  and  inconvenience  of  a  sore  finger  consult  a 
physician?  It  will  be  said  that  it  is  because  his 
finger  is  sore.  I  say  no,  that  is  not  the  reason.  It 
is  because  he  is  mentally  ill  at  ease.  The  reason 
is  a  mental  one  and  not  a  physical  one.  But,  it  will 
be  said,  the  man  has  pain  in  his  finger  and  that  is  a 
physical  fact  and  the  reason  he  consults  his  phy- 
sician.   Again  I  say  no,  that  is  not  so.     The  pain 


INTRODUCTION  9 

does  not  reside  in  the  finger :  pain  is  not  a  physical 
but  a  mental  fact.  While  the  pain  is  directly  due 
to  the  physical  condition  of  the  finger,  the  pain  itself 
is  purely  a  mental  experience.  If  the  man  had  no 
mind  he  could  have  no  pain.  And  so  again  I  con- 
tend that  the  reason  the  man  consults  his  physician 
is  that  he  is  mentally  ill  at  ease.  What  does  the 
physician  do  for  him?  The  usual  answer  will  be 
that  he  cures  the  physical  ailment.  That  is  true. 
But  in  doing  so  he  is  only  employing  that  means 
to  the  end  of  putting  the  patient's  mind  at  rest. 
After  the  patient 's  mind  is  satisfied  then  he  is  well : 
he  no  longer  suffers  pain :  he  no  longer  suffers  from 
the  knowledge  that  there  is  a  disagreeable  looking 
place  on  his  body,  and  he  is  at  peace — ^because,  it 
is  true,  the  physical  cause  of  his  suffering  has  been 
removed.  It  will  be  said  that  this  result  is  accom- 
plished by  dealing  with  the  finger.  I  admit  that  by 
doing  certain  things  to  the  finger  these  results  were 
produced,  but  I  insist  that  the  ultimate  results  pro- 
duced, so  far  as  the  comfort  and  well-being  of  the 
patient  are  concerned,  are  mental  results  and  that 
the  changes  that  were  wrought  in  the  finger  are 
only  to  the  end  of  bringing  about  such  a  mental  con- 
dition. 

This  illustration  serves  to  indicate  how  much 
more  pervasive  are  the  phenomena  of  mind  in  our 
daily  living  than  we  are  wont  to  suppose,  and  also 
how  completely  the  obvious  may  be  overlooked.  A 
convulsion  of  nature,  a  volcanic  eruption  or  an 
earthquake,  a  display  of  the  northern  lights,  an 


10  MENTAL  HYGIENE 

eclipse,  or  the  return  of  a  comet,  are  umisual  and  so 
attract  attention  and  are  observed  with  some  care. 
The  operation  of  our  own  minds  with  which,  not  only 
these  unusual  events  but  all  the  events  of  every  day 
are  perceived,  just  because  it  is,  so  to  speak,  an  in- 
gredient of  every  relation  is  the  least  uncommon 
element  of  all  and  because  of  that  fact  escapes  ob- 
servation and  examination  the  longest  and  the  most 
successfully. 

This  book,  then,  will  proceed  to  an  examination  of 
the  obvious,  in  the  sense  explained,  psychological 
elements  as  they  may  be  found  in  association  with 
and  related  to  the  various  problems  which,  as  I  see 
them,  belong  in  the  realm  of  mental  hygiene. 


CHAPTER  II 
UNDERLYING  CONCEPTS 

Before  we  can  proceed  with  the  program  laid  down 
in  the  Introduction  it  wiU  be  well  to  undertake  to 
come  to  a  somewhat  more  definite  understanding  of 
just  what  is  meant  by  mind,  by  psychological,  and  too, 
by  social.  In  order  to  do  this  it  will  be  necessary  to 
retrace  briefly  the  pathway  along  which  biological 
phenomena  have  finally  found  a  culmination  in  man. 
Briefly  and  dogmatically  sketched  the  important 
points  for  our  present  purposes  are  these : 

The  simplest  type  of  reaction  of  living  beings  is 
physical  and  needs  hardly  to  be  more  than  mentioned 
as  testifying  their  relationship  to  inorganic  nature. 
Such  reactions  have  little  importance  for  the  present 
problem.  Examples  are  the  sweeping  of  living  be- 
ings along  rapidly  flowing  streams  and  ocean  cur- 
rents, the  blowing  of  seeds  and  insects  and  even  birds 
to  great  distances  by  the  winds,  the  changes  in  shape 
and  form  as  conditioned  by  the  environment  (the 
science  of  morphology),  and  the  more  simple  physical 
determiners  in  growth,  the  development  of  organs, 
the  circulation  of  body  fluids,  etc. 

Very  early,  probably  from  the  first,  we  will  find 
associated  with  life  certain  chemical  changes.  These 
changes  are  characteristically  and  fundamentally  the 

11 


12  MENTAL  HYGIENE 

changes  incident  to  digestion  and  metabolism  and  as 
they  are  intimately  bound  up  with  certain  physical 
reactions  such  as  osmotic  tension,  hydrodynamics 
(circulation),  we  may  speak  of  this  group  of  reac- 
tions as  physico-chemical. 

Quite  early  in  the  history  of  evolution  pathways 
were  laid  down  which  enabled  a  reaction  to  take  place 
at  one  part  of  the  body  as  a  result  of  a  stimulus  at 
another  part.  These  are  the  nervous  pathways  and 
were  made  necessary  by  the  growing  size  and  com- 
plexity of  animal  life  and  the  necessity  for  a  more 
accurate  interrelation  between  its  several  parts.  Be- 
cause these  reactions  are  the  expression  of  an  asso- 
ciation between  a  stimulus  (sensation)  and  a  motor 
response  (motion)  reactions  of  this  character  are 
known  as  sensori-motor.  The  simplest  and  earliest 
form  of  reaction  in  this  category  had  as  object  the 
more  accurate  relating  of  the  vital  organs,  more  par- 
ticularly those  engaged  in  digestion  and  circulation, 
and  this  early  nervous  system  probably  corresponded 
roughly  to  what  we  know  as  the  vegetative  nervous 
system  in  man.  It  is  only  relatively  late  in  animal 
evolution  that  we  find  what  we  know  as  a  central 
nervous  system  (brain  and  spinal  cord),  in  fact  not 
until  we  get  to  the  vertebrates,  and  only  at  this  level 
of  development  that  we  get  that  exquisite  develop- 
ment of  the  sense  organs  which  serves  wonderfully 
to  relate  man  to  his  environment. 

Only  after  all  of  this  preparation  do  we  find  that 
there  has  developed  anything  to  which  we  may  give 
the  name  of  psyche  and  to  the  reactions  which  issue 


UNDERLYING  CONCEPTS  13 

the  name  psychological,  while  finally,  by  the  associa- 
tion of  individuals  at  the  psychological  level  of  de- 
velopment there  issues  a  still  more  complex  type  of 
reaction,  the  social. 

With  this  evolutional  scheme  in  mind  we  may  con- 
sider, for  descriptive  purposes  only,  the  various 
types  of  reaction  as  we  see  them  exhibited  in  man. 
The  physical  reactions  are  such  as  are  involved  in 
the  maintenance  of  the  erect  posture,  the  relation 
of  the  various  curves  in  the  spinal  column,  the 
adaptation  of  the  joint  surfaces  to  one  another  and 
numerous  other  reactions  of  a  similar  nature:  the 
chemical  and  physico-chemical  reactions  still  deal 
largely  with  questions  of  growth,  nutrition,  and 
metabolism.  The  sensori-motor  reactions,  mediated 
by  the  central  nervous  system,  occupy  a  still  higher 
plane  and  serve  for  bringing  about  larger  co-ordina- 
tions between  the  various  parts  of  the  body;  while 
the  psychological  and  social  types  of  reaction  are 
hardly  even  approached  by  any  of  the  lower  animals. 

If  we  will  take  the  broadest  concept  of  the  rela- 
tion of  the  individual  to  his  environment  and  of  the 
functions  of  these  various  levels,  if  I  may  so  call 
them,  we  will  see  at  once  that  the  individual  is  al- 
ways endeavouring  to  bring  about  an  adjustment 
between  himself  and  his  surroundings,  and  that  in 
order  to  do  this  he  is  always  in  a  position  where  it 
is  advantageous  to  be  able  to  concentrate  all  efforts 
in  a  given  direction  and  make  everything  subservi- 
ent to  that  particular  end.  The  first  function  is  that 
of  adjustment.    The  second  function  is  that  of  in- 


14  MENTAL  HYGIENE 

tegration,  and  at  each  level  we  find  the  functions  of 
the  organism  serving  both  of  these  ends.  As  we 
proceed  from  the  physical  through  the  various  nerv- 
ous levels  to  the  psychological  level  we  find  that  each 
series  of  functions,  as  they  increase  in  complexity, 
also  serve  more  thoroughly  and  more  efficiently  to 
integrate  the  individual  and  therefore  make  it  possi- 
ble for  him  to  bring  all  of  his  energies  together  and 
concentrate  them  upon  a  specific  goal.  At  the  same 
time  this  function  of  integration  is  the  very  neces- 
sary pre-condition  to  efficiency  of  adjustment  to  the 
environment. 

If  I  were  to  illustrate  the  type  of  instrument  which 
man  uses  at  the  various  levels  to  bring  about  these 
two  ends,  namely,  adjustment  and  integration,  I 
should  name  first,  at  the  physical  level,  the  lever. 
This  is  exemplified  by  the  type  of  action  between 
muscles  and  bones  which  serves  the  purpose  of  in- 
tegrating man's  framework  so  that  he  may  direct 
his  exertions  toward  any  particular  end  he  wishes 
and  thereby  effect  to  that  extent  an  adjustment  with 
his  surroundings.  At  the  next  level,  the  physico- 
chemical,  the  hormone  ^  is  the  type  of  instrument 
which  is  used  to  effect  these  two  purposes.  The 
chemical  regulation  of  metabolism  is  a  means 
whereby  the  body  is  related  to  itself  in  its  different 

1  The  active  principle  of  certain  glands,  the  so-called  ductless 
glands,  such  as  the  thyroid,  the  adrenal,  the  pituitary,  etc.  The 
word  means  a  messenger  and  is  so  used  because  it  serves  to  bring  out 
reactions  at  a  distance.  It  so  works  like  a  nervous  system,  but  is 
a  simpler  and  more  primitive  way,  serving  at  a  time  before  the  lay- 
ing down  of  definite  and  permanent  nervous  pathways. 


UNDERLYING  CONCEPTS  15 

parts  so  that  it  grows  and  develops  as  a  whole,  each 
portion  receiving  and  utilizing  only  its  proper 
amount  and  character  of  nutriment  to  serve  the 
specific  purpose  of  the  development  of  that  part  in 
so  far  as  it  may  be  useful  to  the  whole  organism. 
Integration  is  thus  served,  the  organism  as  a  whole 
is  raised  by  this  integration  to  a  higher  level  of 
efficiency  and  thereby  adjustment  with  the  environ- 
ment to  a  greater  nicety  is  rendered  possible.  This 
hormone  regulation  which  is  effected  through  the 
medium  of  the  endocrine  (ductless)  glands  is  al- 
ready, in  higher  animals,  very  largely  under  the 
control  of  the  vegetative  nervous  system.  So  even 
at  this  level  we  are  dealing  with  nervous  control. 
At  the  next  level,  the  level  of  the  central  nervous 
system,  the  reflex  is  the  type  of  instrument  which  is 
used.  The  reflex  is  brought  into  action  by  contact 
between  the  individual  and  the  environment.  It 
may  be  simple,  it  may  be  compound,  it  may  be  condi- 
tioned^ or  unconditioned,  but  it  is  by  building  up 

2  The  term  conditioned  reflex  was  used  to  describe  certain  phenom- 
ena, resulting  from  his  experiments,  by  the  Russian  physiologist 
Pawlow.  In  his  experiments  on  the  salivary  secretion  in  dogs  he 
found  that  it  was  normally  brought  about  by  the  sight  and  smell  of 
food.  If  now,  for  example,  he  always  rang  a  bell  in  conjunction  with 
showing  the  food  he  found  that  after  a  while,  after  the  association 
food-bell  had  time  to  become  firmly  formed,  if  he  merely  rang  the 
bell  even  though  he  did  not  show  the  food  at  all  the  saliva  was 
nevertheless  secreted.  The  salivary  reflex  was  thus  conditioned  by 
the  sound  stimulus  of  the  bell.  Experiment  showed  that  there  was 
apparently  no  limit  to  the  possibility  of  conditioning  reflexes  in  this 
way.  It  will  be  seen  how  important  is  this  concept  for  the  under- 
Btandng  of  how  complex  systems  of  reflexes  can  be  built  up. 


16  MENTAL  HYGIENE 

series  of  intricately  interrelated  reflexes  that  the 
organism  comes  to  respond  accurately  to  certain 
aspects  of  its  environment.  It  is  needless  to  illus- 
trate further  how  this  process  of  compounding 
of  reflexes  serves  both  the  purposes  of  integration 
and  of  adjustment.  Still  higher  and  further  ad- 
vanced in  the  course  of  evolution  the  type  of  instru- 
ment which  is  brought  into  play  to  effect  these  two 
purposes  is  the  idea?  The  idea  not  only  integrates 
by  keeping  before  the  individual  the  goal  which  he 
is  endeavouring  to  reach  and  thereby  serving  to 
bring  all  his  forces  to  bear  to  that  specific  end,  but 
it  also  reflects  the  environment  much  more  accu- 
rately than  can  the  stimulus  which  brings  about  the 
reflex  and  thereby  leads  to  a  much  finer  adjustment. 
And  last  of  all  we  have  arrived  at  that  region  which 
Spencer  called  the  region  of  supra-organic  evolu- 
tion, the  region  of  social  psychology  in  which  con- 
duct gets  its  values  from  the  approval  or  disap- 
proval of  the  community — ^the  herd — of  which  the 
individual  forms  a  part.  The  type  of  instrument 
which  is  used  at  this  level  to  effect  the  double  pur- 
pose of  integration  and  adjustment  is  the  social  cus- 
tom. Customs  serve  to  integrate  society  rather 
than  the  individual  perhaps  by  binding  all  its  units 
together  to  a  common  end,  but  in  so  doing  they 
serve  also  to  effect  a  more  efficient  adjustment  of 
the  individual  to  the  requirements  of  the  community. 

3  For  a  discussion  of  the  idea  as  sjTubol  and  as  such  as  a  trans- 
fornaer  of  energy  see  the  author's  "Mechanisms  of  Character  Forma- 
tion, An  Introduction  to  Psychoanalysis."  The  Macmillan  Company, 
New  York,  1916. 


UNDERLYING  CONCEPTS  17 

It  will  thus  be  seen  that  in  the  process  of  evolu- 
tion there  is  an  orderly  progression  from  the  low- 
est to  the  highest  types  of  reaction  until  they 
culminate  in  the  reactions,  as  I  have  put  it,  at  the 
psychological  level  and  then  reactions  at  this  level 
finally  take  on  social  values. 

This  brief  summary  which  I  have  given  of  the 
evolution  of  the  various  types  of  reaction,  shows  a 
constant  interplay  between  the  individual  and  his 
environment  which  precludes  the  possibility  of  con- 
sidering the  individual  as  apart  from  the  environ- 
ment. This  impossibility  is  especially  to  be  borne 
in  mind  when  the  individual  is  considered  as  a  so- 
cial unit  and  his  reactions  are  considered  from  the 
standpoint  of  the  social  level. 

From  this  point  of  view,  therefore,  we  see  con- 
duct as  an  end  result  of  the  whole  system  of  mechan- 
isms and  the  compromises  which  have  been  struck  in 
the  progressiva  evolution  of  integration  and  adjust- 
ment. The  psychological  level  is  only  reached  at 
that  stage  in  evolution  when  integration  has  reached 
a  point  of  development  so  that  action  which  results  is 
action  of  the  individual  as  a  whole.  In  fact,  psy- 
chology is  just  that  discipline  which  deals  with  reac- 
tions which  involve  the  individual  as  a  whole.  The 
investigation  of  the  digestive  properties  of  the  pan- 
creatic juice  is  a  physiological  study  at  the  physico- 
chemical  level,  the  investigation  of  the  patella  ten- 
don reflex  (knee  jerk)  is  a  study  of  function  (physi- 
ology) at  the  sensori-motor  level,  an  investigation  of 
the  reasons  a  man  took  a  train  and  went  to  Boston  is 


18  MENTAL  HYGIENE 

a  psychological  study.  Conduct,  therefore,  is  made 
possible  by  these  final  integrations  which  combine, 
unify,  and  centralize  all  lower  integrations  and  psy- 
chology is  the  science  which  deals  with  reactions  at 
this  level. 

Throughout  the  discussion  thus  far  I  have  used 
the  terms  individual  and  environment  as  if  they 
were  mutually  exclusive.  This  is  not  so.  The  con- 
cept individual,  as  implying  a  clear  cut  distinction 
from  the  environment  has  had  a  distinct  history, 
an  evolution  and  a  consideration  of  the  facts  will 
show  that  this  implied  distinction  is  largely  artifi- 
cial.* 

A  study  of  the  development  of  the  child  psyche 
will  show  that  the  child  must  go  through  a  long  and 
tedious  process  in  learning  the  distinction  between 
himself  and  things  about  him,  in  building  up  the  con- 
cepts of  the  ''I"  and  the  *'not-I."  We  see  the  con- 
fusion in  the  child's  mind  well  illustrated  if  we  will 
watch  the  details  of  the  play  with  dolls  and  note 
the  uniformity  with  which  the  various  objects  about 
it  are  personified.  This  same  stage  is  well  seen, 
and  has  been  extensively  studied,  in  primitive  man 
— the  stage  of  animism — ^while  the  elaborately  built 
up  distinction  is  broken  down  in  mental  disease 
with  its  delusions  and  hallucinations,  the  latter  espe- 
cially coming  often  from  inanimate  objects  or  lower 
animals  and  thus  reviving  the  animistic  level  of 
culture. 

4  See  the  author's  "Individuality  and  Introversion,"  The  Psycho- 
analytic Review,  January,  1917. 


UNDERLYING  CONCEPTS  19 

On  tlie  more  physical  side  of  the  relation  we 
would  find,  if  we  tried  to  make  the  distinction  clean 
cut,  that  we  would  have  the  greatest  difficulty  as 
soon  as  we  left  the  plane  of  the  grosser  and  more 
obvious  distinctions.  At  what  point  food  intro- 
duced into  the  gastro-intestinal  tract  or  oxygen  in- 
spired into  the  pulmonary  vesicles  ceases  to  be- 
come a  bit  of  the  environment  and  becomes  part  of 
the  individual  would  be  seen  to  be  quite  unanswer- 
able. 

At  the  social  level  the  indeterminateness  is  still 
more  in  evidence.  The  influence  of  a  person  radi- 
ates about  him  in  ever  widening  circles  if  perhaps 
he  is  a  public  man,  a  speaker  or  writer,  and  may 
even  outlast  the  span  of  his  physical  existence  for 
generations. 

And  finally  the  germ  plasm,  again  material,  hands 
on  qualities  to  the  indefinable  future. 

The  individual  and  the  environment  are  not  mu- 
tually exclusive,  they  exist  rather  as  a  relation  but 
in  that  relation  their  values  are  not  constant.  They 
are  the  two  elements  of  a  relation  which  is  dynamic, 
which  implies,  therefore,  a  constant  interplay  of 
forces,  and  so  their  relative  values  are  in  a  constant 
state  of  flux. 

This  indistinctness  of  the  outlines  of  the  individ- 
ual becomes  of  great  practical  importance  when  we 
come  to  deal  with  the  social  level  of  reactions. 
Just  as  we  have  seen  that  the  individual-environ- 
ment relation  was  a  relation  of  two  independent 
variables  in  which  the  relative  values  were  in  a  con- 


20  MENTAL  HYGIENE 

stant  flux,  so  the  same  state  of  affairs  pertains  to 
the  relation  individual-society.  Many  writers  see 
in  social  psychology  only  the  sum  of  the  individual 
psychologies  of  the  constituent  units.  I  think  this, 
however,  a  grave  mistake.  The  relation  which  the 
individual  bears  to  other  individuals  and  to  the 
group  as  a  whole  is  the  new  element  which  is  intro- 
duced and  forms  a  part  of  man's  make-up  when  con- 
sidered as  a  social  animal.  As  well  say  that  any 
animal  or  plant  can  be  fully  understood  by  under- 
standing the  individual  cells  of  which  it  is  composed. 
Such  a  viewpoint  would  fail  completely  to  take  into 
consideration  the  specialization  of  structure  and 
function  and  the  integration  of  their  several  organs 
and  functions  which  are  functions  of  this  relation 
rather  than  of  the  cells  themselves.  The  relation  as 
such  is  as  much  a  reality  as  the  cell  and  it  is  just  as 
true  as  between  individual  man  and  society  as  it  is 
between  the  individual  cell  and  the  body.  This  is  an 
important  viewpoint  because  it  sees  society  as  an 
integration,  still  higher  than  the  psychological 
level,  in  which  the  individuals  are  grouped  accord- 
ing to  race,  religion,  profession,  trade,  degree  of 
education  and  in  a  thousand  and  one  other  ways, 
much  as  the  cells  of  the  body  are  grouped  into  or- 
gans, and  in  which  all  these  groups  are  integrated 
to  the  common  end  of  the  larger  social  group — the 
herd — as  are  the  cells  to  the  common,  larger  end  of 
the  body. 

One  other  aspect  of  this  matter  of  integration 
which  is  of  importance.    Each  cell,  each  organ,  each 


UNDERLYING  CONCEPTS  21 

individual  has  the  function  first  of  preserving  itself, 
of  continuing  to  live,  broadly,  the  problem  of  nu- 
trition. But  in  addition  to  its  self -preservative  ac- 
tivities it  must  give  something  to  the  group.  This 
is  the  basis  of  that  relationship  that  makes  integra- 
tion possible.  The  carapace  of  the  beetle  must 
maintain  its  own  integrity  but  it  protects  the  deli- 
cate vital  parts  of  the  animal  which  it  encloses ;  the 
liver  has  to  maintain  itself  as  liver,  but  it  stores  up 
glycogen — muscle  food — ^to  be  called  upon  in  an 
emergency  and  so  supplies  its  quota  to  the  prepared- 
ness of  the  body  as  a  whole  against  danger ;  the  in- 
dividual man  must  obtain  food  and  shelter  for  him- 
self, but  in  addition  he  must  pay  his  taxes  and  so 
contribute  to  the  needs  of  the  herd. 

All  this  is  preliminary  but  necessary  to  the  un- 
derstanding of  the  place  that  the  psychological  type 
of  reaction  occupies  in  the  general  scheme  of  the 
individual's  development,  and  it  is  also  necessary 
to  the  understanding  of  how,  by  a  process  of  evo- 
lution, the  type  of  reaction  which  the  individual 
manifests  gets  its  values  reflected  from  the  herd. 
Conduct  is  the  basis  upon  which  the  conununity 
judges  the  individual.  The  individual  may  think  as 
he  pleases  and  the  community  has  no  interest  in  his 
thoughts,  but  he  must  act  along  fairly  well  defined 
lines  if  he  expects  to  be  left  undisturbed.  Conduct, 
therefore,  has  a  social  value  and  its  social  value  is 
based  upon  its  worth  to  the  community.  Every  in- 
dividual owes  certain  duties  to  the  community  in 
which  he  lives  in  return  for  the  immense  benefits 


22  MENTAL  HYGIENE 

that  that  community  bestows  upon  him.  Practically 
all  of  the  things  for  which  we  consider  life  worth 
living  are  made  possible  by  the  social  organization, 
and  in  return  for  all  these  gifts  from  society  the 
individual  has  a  duty  towards  that  society.  It  is 
upon  the  basis  of  the  efficiency  with  which  he  dis- 
charges this  duty  that  society  passes  judgment  upon 
his  conduct  and  deals  with  those  departures  from 
certain  standards  which  it  sees  fit  to  maintain. 

From  this  standpoint  we  see  the  individual  evalu- 
ated on  the  basis  of  his  usefulness  to  the  community 
as  expressed  in  his  conduct.  Conduct,  as  we  have 
seen,  is  psychological  and  so  it  is  proper  to  in- 
quire whether  all  forms  of  social  inefficiency  may 
not  be  viewed,  and  properly  so,  from  the  standpoint 
of  mental  deficiency.  The  so-called  insane  and  the 
various  grades  of  the  feeble-minded  are  already 
viewed  in  this  way,  while  there  is  pretty  general 
agreement  that  approximately  fifty  per  cent  of  crim- 
inals and  an  equal  percentage  of  prostitutes  easily 
fall  within  such  a  grouping.  To  my  mind  it  will 
be  useful  to  look  at  all  the  socially  inefficient  classes 
in  this  way.  If  we  can  do  this  without  being  ham- 
pered by  such  old-time  and  misleading  concepts 
as  "insanity*'  and  ''criminality"  (as  if  insanity 
and  criminality  were  tangible  entities  that  took  up 
their  residence  within  certain  individuals),  if  we  can 
look  upon  socially  inefficient  types  of  reaction  in  the 
broad  way  in  which  I  have  indicated,  rather  than 
from  the  narrow  viewpoint  of  certifiability  and  con- 


UNDERLYING  CONCEPTS  23 

viction,  we  shall  commence  to  understand  and  to 
deal  effectively  with  the  socially  inadequate. 

If  we  take  this  viewpoint  for  the  moment  and  look 
at  this  fifty  per  cent,  of  asocial  individuals  and  real- 
ize that  they  cannot  live  in  the  community  as  use- 
ful citizens  but  have  to  be  shut  up  in  some  form  of 
institution,  and  then  place  this  fact  by  the  side  of 
our  scheme  of  evolution  of  reactions,  we  see  in- 
stantly that  these  individuals  fail  at  the  social  level. 
It  is  not  necessary  to  find  in  such  persons  plain  evi- 
dences of  mental  defect  which  show  themselves  at 
what  I  have  called  the  purely  psychological  level. 
Many  such  individuals  are  well  behaved,  well  con- 
ducted, and,  relatively  at  least,  efficient  persons 
within  the  milieu  of  an  institution.  Subjected  to 
the  increased  complexities  with  the  resulting 
stresses  of  social  life,  however,  they  show  imme- 
diately their  inability  to  make  adequate  adjustment. 
They  fail  at  the  social  level  of  adjustment,  and  to 
say  that  this  failure  is  not  psychological  is  to  lack 
in  appreciation  of  what  psychological  means. 

To  illustrate  let  me  cite  extreme  examples.  Let 
us  take  the  cases  of  a  pauper  and  a  criminal.  Each 
fails  to  make  a  satisfactory  social  adjustment. 
The  main  difference  between  the  two  types  of  fail- 
ure is  difference  in  the  particular  way  in  which  the 
failure  has  come  about.  In  one  instance  (the  crim- 
inal) there  has  been  a  positive  offence  against  the 
standards  of  the  herd,  and  in  the  other  (the  pauper) 
there  has  not.    The  intellectual  level,  or  the  depth 


24  MENTAL  HYGIENE 

of  defect  from  whicli  the  individual  suffers,  may  be 
the  same  in  both  instances.  Let  us,  however,  take 
as  an  example  the  individual  who  has  gone  to  the 
poorhouse  because  he  can  no  longer  earn  his  living ; 
perhaps  he  has  lost  an  arm  or  a  leg,  or  his  vision, 
or  some  other  organ  or  function  upon  which  he 
has  been  accustomed  very  largely  to  depend.  One 
would  naturally  say  that  such  a  case  certainly 
showed  no  psychological  evidences  of  deficiency — 
that  the  difficulty  was  entirely  physical.  I  do  not 
think  that  is  a  fair  way  to  judge  the  situation. 

I  have  in  mind  Miss  Helen  Keller,  who  in  her  earli- 
est infancy  was  stricken  absolutely  blind  and  to- 
tally deaf.  This  young  woman  to-day  is  not  only  a 
highly  respected  and  much  loved  member  of  the 
community,  but  she  is  highly  efficient.  She  writes 
beautifully,  she  takes  the  lecture  platform  effec- 
tively, and  she  has  trained  her  other  senses,  to  take 
the  place  of  those  which  were  lost,  in  a  manner 
which  is  nothing  short  of  marvelous.  She  gets  from 
life  all  of  the  wonder  that  a  highly  cultured  and 
highly  educated  individual  can  with  his  senses  in- 
tact, and  vastly  more  than  the  average  normal  in- 
dividual. Now  when  we  see  a  person  (perhaps  he  is 
a  blacksmith,  it  matters  not)  go  to  the  poorhouse 
because  he  has  lost  an  arm,  the  only  reasonable  ex- 
planation that  we  can  give  for  such  conduct  is  that 
his  inefficiency  is  psychological.  We  may  express 
it  in  such  common  phrases  as  **he  has  lost  his 
nerve,"  or  **he  is  unequal  to  making  a  readjust- 
ment," ''he  is  too  old  to  begin  over  again,"  or  in  a 


UNDERLYING  CONCEPTS  25 

thousand  other  ways,  but  reduced  to  their  greatest 
common  divisor,  to  resort  to  a  mathematical  figure, 
the  common  element  in  all  of  these  formulae  is  the 
element  of  mental  inefficiency. 

It  is  only  when  we  begin  to  see  the  true  meanings 
of  the  failures  in  life  as  they  surround  us  that  we 
are  able  to  approach  the  problem  of  mental  defi- 
ciency in  a  practical  way  through  the  natural  ave- 
nues. The  main  emphasis  of  the  argument  should 
be  upon  the  fact  that  socially  efficient  conduct  is  an 
end-result,  depending,  not  alone  upon  psychological 
integrity,  but  back  of  that  upon  integrity  at  all  the 
various  reaction  levels  as  I  have  described  them. 
Each  level  is  dependent  upon  the  one  beneath — its 
historical  antecedent.  Conduct  is  the  end-result  of 
the  whole  complex  of  mechanisms  and  the  resulting 
compromises  and  its  efficiency  is  a  function  of  their 
integrity. 

In  the  preface  to  our  recent  work  on  the  Diseases 
of  the  Nervous  System,^  Dr.  Jelliffe  and  I  have  said : 
*  *  Man  is  not  only  a  metabolic  apparatus,  accurately 
adjusted  to  a  marvelous  efficiency  through  the  in- 
tricacies of  the  vegetative  neurological  mechanisms, 
nor  do  his  sensori-motor  functions  make  him  solely 
a  feeling,  moving  animal,  seeking  pleasure  and 
avoiding  pain,  conquering  time  and  space  by  the 
enhancement  of  his  sensory  possibilities  and  the 
magnification  of  his  motor  powers;  nor  yet  is  he 

5  Jelliffe  and  White :  "Diseases  of  the  Nervous  System.  A  Text- 
Book  of  Neurology  and  Psychiatry."  Published  by  Lea  &  Febiger, 
Philadelphia  and  New  York,  2nd  Ed.,  1917. 


26  MENTAL  HYGIENE 

exclusively  a  psychical  machine,  which  by  means  of 
a  masterly  symbolic  handling  of  the  vast  horde  of 
realities  about  him  has  given  him  almost  unlimited 
powers.  He  is  all  three,  and  a  neurology  of  to-day 
that  fails  to  interpret  nervous  disturbances  in  terms 
of  all  three  of  these  levels,  takes  too  narrow  a  view 
of  the  function  of  that  master  spirit  of  evolution, 
the  nervous  system." 

And  now  finally,  and  this  is  very  important. 
Conduct  at  the  psychological  level  does  not  by  any 
means  necessarily  imply  conduct  that  is  motivated 
and  carried  out  with  clear  conscious  knowledge. 
The  evolution  of  the  different  levels  of  integration 
has  been  a  long  one,  extending  back  through  the 
ages,  and  has  finally  reached  its  culmination  via  the 
route  which  passes  through  the  lower  animals. 
Mankind,  therefore,  shares  many  of  its  tendencies 
with  them.  The  social  tendency  itself — gregarious- 
ness — is  shared  with  a  large  number  of  animals,  the 
buffalo,  deer  and  horse,  with  birds  and  even  with 
insects,  ants,  bees,  and  wasps.  Conduct  based  upon 
such  a  tendency,  therefore,  has  become  so  well  in- 
grained in  the  individual  that  it  is,  as  we  say, 
automatic,  and  while  the  individual  may  know  what 
he  is  doing  the  underlying  motive  is  buried  deep  be- 
yond his  powers  of  insight,  in  his  history.  Such 
conduct  while  it  is  psychological  in  the  sense  in 
which  I  have  used  it,  that  is,  involves  the  final  in- 
tegrations and  so  the  individual,  as  a  whole,  is  mo- 
tivated by  causes  which  lie  far  outside  the  realm  of 
his  knowledge  of  himself.    This  is  the  conduct  to 


UNDERLYING  CONCEPTS  27 

which  the  term  instinctive  is  applied  and  while  it 
is  strictly  at  the  psychological  level  there  is  little  or 
no  conscious  motivation.  Psychological  reactions, 
therefore,  do  not  necessarily  imply  consciousness,  in 
the  sense  in  which  we  ordinarily  use  that  term,  a 
fact  which  is  of  great  importance  in  understanding 
many  reactions,  particularly  abnormal  and  patho- 
logical types.  Such  conduct  has  its  origin  in  the 
psyche  but  not  in  consciousness — the  motives  lie  in 
the  unconscious.^ 

Depending  upon  their  history,  therefore,  we  may 
have  acts  of  conduct  by  deeply  unconscious  motives 
or  by  clearly  conscious  motives  and  by  motives 
which  occupy  any  point  in  the  interval,  possess  any 
degree  of  consciousness. 

The  practical  importance  of  this  proposition  is 
great.  The  great  majority  of  things  we  do  are  done 
instinctively,  with  little  or  no  thought,  from  mo- 
tives which  come  from  the  great  region  of  the  un- 
conscious. In  fact,  far  from  consciously  knowing 
our  motives  we  do  not  even  know  they  exist,  we 
never  even  think  of  inquiring  into  them.  Why  do 
we  drink  when  we  are  thirsty?  Why  do  we  laugh 
when  something  pleases  us?  Who,  but  a  philos- 
opher or  scientist,  ever  thinks  to  even  ask  such 
questions  ? 

Conduct  based  upon  such  instinctive  reactions  is 
very  common  and  of  great  importance  in  under- 
standing human  behaviour  in  general,  and  also  of 

6  For  a  discussion  of  the  unconscious  see  "Mechanisms  of  Char- 
acter  Formation." 


28  MENTAL  HYGIENE 

great  significance  for  mental  hygiene.  Trotter  "^  de- 
votes some  space  to  a  description  of  conduct  of  this 
instinctive,  irrational  sort.  When  an  opinion  is  en- 
tertained with  a  feeling  that  it  would  be  absurd, 
obviously  unnecessary,  unprofitable,  undesirable, 
bad  form,  or  wicked  to  inquire  into  it,  then  we  know 
that  the  opinion  in  question  is  held  instinctively  and 
not  as  the  result  of  individual  experience.  It  is 
held  because  of  its  obviousness,  which  is  another 
way  of  saying  because  it  is  dictated  by  the  herd,  that 
is,  by  the  group  of  which  the  individual  holding  it 
forms  a  part.  Opinions  which  are  held  as  the  re- 
sult of  experience  do  not  offer  such  resistances  to 
being  inquired  into.  There  is  no  such  resistance  to 
inquiry  into  the  phenomena  of  physics  and  chem- 
istry, the  problems  of  mathematics,  the  proving  of  a 
geometrical  theorem,  but  about  matters  of  religion, 
morals  and  politics  it  is  largely  in  evidence.  In 
fact  most  of  our  opinions  have  been  built  up  by  the 
herd  and  we  reflect  them  after  this  instinctive  fash- 
ion. All  of  which  goes  to  show  that  much  too  much 
credit  is  given  to  reason  for  the  running  of  this  ma- 
chine of  ours  while  as  a  matter  of  fact  what  we  do 
is  the  expression  of  our  whole,  vast  past  concen- 
trated upon  the  problem  of  the  present. 

The  relative  unimportance,  for  our  everyday  con- 
duct, of  clear  consciousness  and  reason  should  not 
surprise  us  if  we  bear  in  mind  just  the  barest  out- 
lines of  man's  history  on  earth.     From  the  earliest 

7  W.  Trotter :  "Instincts  of  the  Herd  in  Peace  and  War."  London, 
1916, 


UNDERLYING  CONCEPTS  29 

appearance  of  man  upon  the  earth  as  calculated 
from  a  study  of  his  remains,  that  is  from  the  ap- 
pearance of  Pithecanthropus  or  the  Trinil  race,  it 
is  estimated  that  a  period  of  five  hundred  thou- 
sand years  has  elapsed,  a  period  almost  one  hun- 
dred times  greater  than  the  total  extent  of  historic 
times.^  From  a  consideration  of  this  fact,  a  study 
of  the  anatomical  remains,  and  a  consideration  of 
the  facts  of  psychology  as  revealed  in  history  and 
the  study  of  contemporary  peoples  the  conclusion  is 
apparent  that  the  similarities  between  any  two  per- 
sons, no  matter  how  far  removed  they  may  be  from 
one  another  according  to  the  existing  social  stand- 
ards, are  not  simply  more  numerous  than  their  dis- 
similarities but  that  there  is  literally  no  comparison. 
The  similarities  are  vastly  greater  than  the  differ- 
ences, which  latter  can  only  maintain  in  regard  to 
the  very  last,  relatively  speaking  almost  micro- 
scopically thin  layer  which  has  been  added  in  recent 
times.  If  we  consider  only  the  anatomical  and  the 
physiological  similarities  we  will  be  prepared  to  ac- 
knowledge this  at  once.  The  differences  at  these 
levels  are  not  only  inconsiderable  but  for  the  most 
part  unimportant.  A  study  of  the  psychological 
level  will  show  the  same  thing.  The  great  majority 
and  the  overwhelmingly  more  powerful  motives  for 
conduct  come  from  the  great  region  of  the  uncon- 
scious where  this  vast  region  of  man's  past  is 
stored. 

8  Osborn,  H.  F. :  "Men  of  the  Old  Stone  Age,  Their  Environment, 
Life  and  Art."  Published  by  Charles  Scribner's  Sons,  New  York, 
1916. 


30  MENTAL  HYGIENE 

Because  of  the  preponderance  of  similarities  be- 
tween ourselves  and  others  we  must  be  prepared  to 
see  ourselves  in  those  others,  to  look  in  the  phenom- 
ena we  are  studying  for  reflections  of  ourselves. 
In  orienting  himself  towards  personal  and  social 
problems  man  has  ever  been  too  prone  to  forget 
that  he  was  one  element  in  the  relation.  He  has 
too  often  failed  to  see  that  what  he  perceived 
was  dependent  upon  how  he  perceived  it.  This  we 
shall  find  to  be  of  the  utmost  practical  importance  if 
we  are  to  clarify  our  vision  for  useful  ends. 

Mental  hygiene  is  therefore  the  last  word  in  pre- 
ventive medicine.  The  asylum,  the  prison,  the 
poorhouse  are  where  we  find  the  results  of  failure. 
Such  types  of  failure  as  are  represented  in  these  in- 
stitutions will,  of  course,  always  be  with  us,  but  the 
work  of  mental  hygiene  is  not  primarily  with  them 
except  in  so  far  as  they  are  salvable.  Mental 
hygiene  is  primarily  addressed  to  preventing  such 
failures  whenever  possible. 

For  a  great  many  mental  disorders,  especially  the 
various  types  of  ''nervousness"  and  the  so-called 
"functional"  conditions — ^the  benign  as  opposed  to 
the  more  serious  types  founded  upon  marked  de- 
fect— for  such  conditions  especially  among  adults, 
the  public  hospital  for  mental  diseases,  the  psycho- 
pathic clinic,  and  the  public  dispensary,  are  the 
natural  avenues  through  which  to  extend  help.  It 
will  take  some  little  time,  however,  and  some  effort 
before  the  mass  of  people  know  that  such  agencies 
exist  or  are  available  and  also  some  little  time  and 


UNDERLYING  CONCEPTS  31 

effort  before  there  are  enough  of  such  agencies  or 
those  that  do  exist  are  prepared  to  meet  such  de- 
mands. 

For  the  more  serious  conditions,  particularly  for 
the  frankly  defective  states,  the  schools  are  the 
places  in  which  to  work.  Here  the  individual  is 
found  at  an  early  age  when  remedial  agencies  will  be 
effective  if  ever,  and  if  not  then  steps  can  be  taken 
to  spare  society  an  enormous  amount  of  waste  en- 
ergy in  trying  to  make  a  useful  citizen  out  of  ma- 
terial that  can  never  arrive. 

In  this  connection  there  must  be  considered  the 
whole  problem  of  education.  The  study  of  the  atyp- 
ical and  subnormal  child  has  brought  into  relief 
certain  vital  problems  in  our  educational  scheme. 
Many  modifications  are  already  working  throughout 
this  scheme,  and  it  is  ever  coming  nearer  and  nearer 
the  ideal  of  fitting  the  educational  treatment  to  the 
individual  rather  than  expecting  all  individuals  to 
fit  the  same  educational  mould.  We  would  not  think 
of  prescribing  mountain  climbing  to  a  person  with  a 
broken  cardiac  compensation ;  we  should  be  as  care- 
ful in  our  educational  prescriptions.  Here  comes 
also  the  problem  of  vocational  training,  a  still  more 
specific  attempt  to  make  educational  means  serve 
living  ends. 

Going  deeper  still,  all  problems  of  factory  sani- 
tation, of  the  employment  of  women  and  children, 
of  employers'  liability  acts,  working  men's  insur- 
ance organizations,  dangerous  occupations,  compul- 
sory education  and  innumerable  others,  all  take  on  a 


32  MENTAL  HYGIENE 

new  aspect  when  viewed  in  the  light  of  the  ultimate 
goal,  the  end  product  of  individual  development, 
socially  efficient  conduct.  Viewed  in  this  light  they 
are  all  problems  of  mental  efficiency  and  so,  from 
this  angle,  belong  to  the  field  of  mental  hygiene. 
This  is  true,  too,  of  eugenics  which  is  a  worse  than 
useless  effort  unless  it  rests  upon  the  broadest  of 
foundations. 

And  so  the  mental  hygiene  movement  is  a  move- 
ment calculated  to  push  the  whole  problem  of  the 
consideration  of  the  sick  individual  to  a  little  higher 
plane.  It  has  been  the  custom  to  treat  the  child 
with  Pott 's  disease  so  as  to  bring  about  an  arrest  of 
the  tubercular  process  and  subsequent  cure  of  the 
disease.  The  problem  now  becomes  one  of  helping 
the  individual  to  get  the  maximum  of  good  from  life 
in  individual  expansion  and  by  social  usefulness. 
This  aspect  is  being  met  now  by  the  nurse  who  goes 
to  the  house  of  the  patient  and  helps  regulate  his 
way  of  living  after  he  leaves  the  hospital.  We  will 
probably  see  further  developments  along  this  line. 

From  this  higher  plane  of  observation  the  crim- 
inal law  that  punishes  is  unintelligent.  Disorders 
of  conduct  need  constructive  handling.  To  destroy 
the  individual  either  by  capital  punishment  or  by  the 
slower  process  of  constant  repression  is  a  low  level 
means  of  meeting  the  situation. 

The  mental  hygiene  movement  has  as  one  of  its 
functions  the  encouragement  of  all  those  lines  of 
inquiry  and  research  that  lead  to  a  better  knowledge 
of  the  human  animal,  particularly  his  conduct  reac- 


UNDERLYING  CONCEPTS  33 

tions.  It  is  the  task  of  mental  hygiene  to  find  less 
wasteful,  more  efficient  means  for  dealing  with  the 
problems  that  arise  at  this  level,  and,  when  found, 
to  urge  such  measures  unceasingly  upon  those  who 
make  and  administer  our  laws  and  direct  the  trends 
of  public  thought. 


CHAPTER  ni 
MENTAL  MECHANISMS 

In  order  that  we  may  approach  the  various  prob- 
lems that  present  themselves  for  the  application  of 
the  principles  of  mental  hygiene — ^in  order  that  we 
may  discuss  these  problems  without  the  necessity  of 
repeating  these  general  principles  each  time — in  or- 
der, therefore,  that  we  may  discuss  to  the  best  ad- 
vantage practical  issues  which  involve  problems  at 
the  psychological  level,  I  shall  discuss  in  this  chapter 
those  features  of  psychological  integration  and  ad- 
justment which  are  pertinent  to  these  various  issues. 
In  other  words,  I  shall  discuss  in  this  chapter  those 
fundamental  mental  mechanisms,  an  understanding 
of  which  is  necessary  in  order  to  intelligently  ap- 
proach the  various  practical  applications  of  the 
principles  of  mental  hygiene. 

THE  UNCOlsrSCIOUS 

First  of  all,  the  great  fact,  it  seems  to  me,  which 
has  always  to  be  borne  in  mind,  is  the  fact  that  our 
psyche  bears  the  record  of  its  hundreds  of  thousands 
of  years '  development  within  itself  as  truly  as  does 
our  body.  This  is  perhaps  one  of  the  hardest,  one 
of  the  most  difficult  facts,  for  those  who  have  not 
been  thinking  along  these  lines,  to  appreciate,  be- 

34 


MENTAL  MECHANISMS  35 

cause,  of  course,  this  record  is  not  present  in  con- 
sciousness and,  therefore,  remains  unknown  to  us 
unless  exposed  by  a  special  technique.  The  mind 
seems  to  most  of  us  to  be  a  something  mysterious,  if 
we  think  enough  about  it  to  even  get  to  such  a  con- 
clusion, which  lives  only  in  the  present,  which  deals 
only  with  the  problem  now  before  it.  If  we  think 
a  little,  however,  we  realize  that  we  spend  many 
years  in  getting  what  we  call  an  education  to  enable 
us  to  do  this  thing  and  that  in  some  way  or  other, 
the  things  that  we  learn  during  this  educational  pe- 
riod are  preserved  and  can  be  made  available  later 
on  in  dealing  with  our  special  problems.  But  to 
realize  that  not  only  are  the  facts  of  education  which 
we  learned  twenty,  thirty,  forty  years  ago  available 
to-day,  but  that  the  record  of  hundreds  of  thousands 
of  years  is  summed  up  in  this  mind  of  ours,  is  much 
more  difficult  to  grasp. 

Each  one  of  us  carry  innumerable  traces  in  our 
bodily  structure  of  the  path  of  development  along 
which  we  have  come.  Each  of  us,  for  example,  have 
the  remnants  of  gill  slits,  which  testify  our  relation- 
ship in  the  past  to  fishes,  and  each  of  us,  unlovely  as 
the  fact  may  be,  has  the  remnants  of  a  tail,  which 
testifies  to  our  more  recent  simian  ancestors.  Is  it 
after  all  so  strange  that  when  we  come  to  analyze 
the  structure  of  the  mind  that  we  should  find  there 
also  just  as  definite  evidences  of  a  remote  past  as  we 
find  in  the  body? 

This  is  the  historical  past  of  the  psyche,  the  un- 
conscious, it  has  been  called,  because  its  content 


36  MENTAL  HYGIENE 

while  a  part  of  the  psyche  is  still  not  in  conscious- 
ness. 

We  have  first  to  realize  that  all  progress  is 
effected  by  overcoming  resistance.  The  next  thing 
to  realize  is  that  this  resistance,  when  it  becomes 
psychological,  is  located  in  this  vast  historical  past 
of  the  psyche,  which  we  call  the  unconscious.  Let 
me  illustrate  what  I  mean  by  this :  Man  is  a  gre- 
garious animal.  He  does  not  and  cannot  live  alone, 
and  as  in  the  process  of  development  the  group  with 
which  he  allied  himself  has  grown  from  a  simple 
band  of  wanderers,  hunting  and  fishing  for  their 
food  and  confined  to  relatively  warm  climates,  be- 
cause they  did  not  know  enough  to  make  clothes  to 
protect  them  from  the  cold,  as  this  band  has  grad- 
ually evolved  and  enlarged  until  it  has  become  what 
we  call  to-day  a  nation,  the  individual  members  have 
had  gradually  to  readjust  to  ever  increasingly  com- 
plex conditions.  This  readjustment  has  meant  that 
they  have  had  to  progressively  abandon  immediate 
personal  aims  for  more  remote  ones,  to  give  up  in- 
sistent selfish  desires  because  they  were  opposed  to 
the  welfare  of  the  group.  As  society  becomes  more 
complex  it  becomes  increasingly  impossible  for  any 
individual  to  follow  his  own  selfish  instincts  to  the 
exclusion  of  others.  His  path  crosses  the  interests 
of  others  more  and  more  frequently  so  that  constant 
readjustment  has  produced  an  ever  increasing  neces- 
sity for  putting  aside  immediate  personal  satisfac- 
tions because  they  conflicted  with  the  interests  of 
others.    These  readjustments  have  been  necessary 


MENTAL  MECHANISMS  37 

in  order  that  society  should  continue  to  expand  and 
in  order  that  man  might  reap,  in  return  for  his  sac- 
rifices, the  benefits  that  come  from  such  expansion. 
I  need  not  define  what  these  benefits  are  further  than 
to  say  that  they  result  in  a  constant  specialization 
on  the  part  of  the  different  members  of  the  social 
group  which  bring  to  the  individuals  of  the  group 
results  far  superior  to  those  which  could  be  other- 
wise attained. 

Now  as  man  goes  forward  and  is  successful,  con- 
stantly readjusting  to  greater  demands,  the  adjust- 
ments which  he  leaves  behind,  which  he  abandons  in 
his  progress,  go  to  build  up  this  great  region  of  his 
unconscious,  and  as  will  be  seen  this  region  con- 
stitutes by  far  the  greater  part  of  the  psyche. 
Every  readjustment  that  is  made,  therefore,  has  to 
reckon  with  this  past,  has  so  to  speak,  to  overcome 
it,  and  herein  lies  the  conflict  about  which  so  much 
has  recently  been  written.  It  is  the  conflict  between 
man's  aspirations,  his  hopes,  which  he  consciously 
entertains  and  which  involve  sacrifice  in  their  attain- 
ment, and  his  historic  past  which  drags  him  back 
and  makes  him  desire  the  path  of  least  resistance, 
which  is  selfish.  Dr.  Hall  has  illustrated  this  situa- 
tion most  happily  by  using  the  simile  of  the  iceberg. 
The  iceberg  is  nine-tenths  submerged,  and  although 
it  may  appear  that  its  motion  is  controlled  by  the 
forces  which  act  upon  its  visible  portions,  yet  we 
very  frequently  see  that  this  is  not  so,  that  the  great 
submerged  nine-tenths  often  move  it  in  direct  oppo- 
sition to  winds  and  superficial  currents.    And  so  it 


38  MENTAL  HYGIENE 

is  with  the  unconscious, — its  motive  power  has  al- 
ways to  be  reckoned  with  and  oftentimes  it  moves  us 
to  action  in  a  direction  quite  contrary  to  that  which 
we  would  consciously  choose.  The  unconscious 
wishes  are,  therefore,  always  selfish.  They  may  be 
expressed  in  terms  of  the  "will  to  power.''  They 
desire  the  greatest  possible  development  of  the  in- 
dividual, the  maximation  of  his  ego,  whereas  prog- 
ress can  only  take  place  by  sacrificing  something  of 
this  desire,  giving  it  up  in  order  to  attain  to  some- 
thing higher  and  something  better. 

THE  INSTINCT  FOR  THE  FAMILIAB THE  SAFETY  MOTIVE 

To  be  more  specific  let  me  trace  the  way  in  which 
this  conflict  arises  in  the  individual.  The  baby,  in 
its  mother's  uterus,  may  be  said  to  be  omnipotent, 
that  is,  it  has  no  nngratified  desires,  it  does  not  have 
to  eat,  to  breathe,  or  do,  in  fact,  anything.  All  the 
functions  are  performed  for  it,  and  it  rests  quietly 
and  undisturbed  in  a  warm  fluid  in  which  it  floats 
without  effort.  When  the  child  is  born  there  is  born 
at  the  same  time :  desire.  Ail  of  these  comforts,  so 
to  speak,  are  given  up  and  the  child  is  thrust  into  a 
world  in  which  it  will  never  know  again  the  peace 
that  has  been  left  behind.  About  the  first  thing  a 
child  does  is  to  cry,  its  futile  protest  against  the 
demands  of  reality,  and  the  way  in  which  this  cry 
is  stilled  by  the  nurse  is  to  wrap  it  up  in  warm 
blankets  and  put  it  in  a  dark  room,  thus  reproducing 
as  nearly  as  possible  the  intra-uterine  condition. 
From  now  on  there  is  a  constant  conflict,  between  the 


MENTAL  MECHANISMS  39 

desire  of  the  baby  to  seek  comfort  and  rest  on  the 
one  hand,  and  the  insistent  demands  of  the  world  of 
reality,  which  never  for  a  moment  cease  their  efforts 
to  obtain  recognition.  All  sorts  of  lights  and 
shadows  play  about  the  baby,  all  kinds  of  sounds 
assail  his  ear,  new  sensations  come  from  his  skin  at 
every  point,  and  he  must  needs  pay  some  attention 
to  all  these  multiple  stimuli — make  some  kind  of 
adjustment  to  them.  Here  is  the  beginning  of  the 
conflict,  the  struggle  for  ascendancy  between  what 
has  been  called  the  pleasure-pain  and  the  reality 
principles  or,  as  I  prefer  to  say,  between  the  pleas- 
ure motive  and  the  reality  motive  for  conduct.  The 
baby  would  fain  continue  in  the  luxury  of  soft,  warm 
blankets,  in  the  darkness  and  away  from  all  sources 
of  stimulation,  but  reality  is  not  to  be  so  easily  side- 
tracked, it  breaks  through  all  his  defences  by  skin, 
eye,  and  ear  stimuli,  by  hunger  and  thirst,  and  in 
innumerable  other  ways  demands  and  obtains  recog- 
nition. 

Here  we  find,  in  its  simplest  terms,  the  struggle 
between,  what  may  be  called  instinct,  on  the  one 
hand  and  reality  on  the  other.  The  baby  exhibits  in 
his  reactions  the  paradigm  for  all  his  future  difficul- 
ties in  life,  he  prefers  to  remain  attached  to  that 
which  he  has  become  familiar  with,  resists  and  re- 
sents those  forces  that  compel  him  to  leave  the 
familiar  for  the  unfamiliar,  to  abandon  the  known 
for  a  venture  into  the  region  of  the  unknown.  I  will 
call  this  type  of  reaction  the  reaction  of  the  instinct 
for  the  familiar — the  safety  motive. 


40  MENTAL  HYGIENE 

Without  following  further  the  details  of  this  won- 
derful period  of  life,  we  may  jump  to  a  little  later 
time,  when  we  find  the  baby  old  enough  to  be  sitting 
up  and  playing  with  things  which  have  been  given 
him.  Suppose  he  plays  with  his  rattle  for  a  while 
and  then  drops  it.  Some  one  is  standing  by  to  pick 
up  the  dropped  rattle  and  to  put  it  again  into  the 
baby's  hands.  The  household  is  at  the  baby's  com- 
mand, there  is  always  some  one  standing  about  to 
wait  upon  him,  to  do  the  thing  that  he  wants  done. 
He  has  given  up  some  of  the  comforts,  but  he  still 
retains  a  tremendous  command  over  his  surround- 
ings. He  gives  up  his  omnipotence  only  under  the 
duress  of  the  unavoidable  demands  of  reality:  he 
resents  his  slowly  failing  command  over  his  environ- 
ment :  his  reactions  show  his  desire  to  hang  on  to  his 
waning  powers :  they  are  the  reactions  of  the  instinct 
for  the  familiar — the  safety  motive. 

From  now  on  for  a  considerable  time  the  infant 
is  in  what  corresponds  to  the  cultural  level  of  ani- 
mism as  it  is  designated  when  applied  to  primitive 
man.  This  is  typically  seen  in  the  play  of  the  child. 
The  dolls  are  not  only  personified  but  are  given 
definite  personalities  which  are  developed,  often 
with  great  elaboration,  as  time  goes  on.  Not  only 
the  dolls  but  the  whole  environment  tends  to  be 
given  personal  attributes.  The  animals  are  con- 
versed with  and  become  intimate  friends,  while  even 
inanimate  nature  is  dealt  with  in  similar  ways. 
Trees,  chairs  and  tables  are  addressed,  the  stars 
look  down  as  persons  upon  the  child  and  are  com- 


MENTAL  MECHANISMS  41 

mimicated  with,  while  the  moon  often  becomes  an 
intimate  confidant. 

The  type  of  reaction  which  belongs  to  this  ani- 
mistic stage  of  development  is  only  relinquished 
with  great  difficulty,  and  indicates  the  extent  of  his 
failure  to  separate  himself  completely  from  his  en- 
vironment. It  testifies  to  the  reality  of  the  individ- 
ual-environment relation,  as  set  forth  in  the  last 
chapter,  for  while  during  all  this  period  of  develop- 
ment he  is  engaged  in  a  profound  research  which 
has  the  very  purposes  of  separating  himself  from 
his  environment,  of  finding  out  just  what  belongs  to 
him  and  what  does  not,  still  his  reactions  in  later  life 
show  wherein  he  has  failed. 

To  give  an  example  that  will  be  easily  recognized. 
An  individual  has  a  task  to  perform,  perhaps  the 
writing  of  a  letter.  Instead  of  sitting  down  and 
doing  it  he  becomes  surly  and  irritable  and  finally 
when  he  does  start  to  do  it  he  writes  out  the  first 
portion,  it  does  not  suit  him,  and  he  tears  it  up  in 
anger,  throws  it  down  and  makes  use  of  certain  ex- 
pressions which  indicate  clearly  that  he  is  personi- 
fying the  letter,  that  is  the  paper,  the  task.  The 
explanation  of  such  conduct  is  that  it  is  infantile  in 
several  respects.  He  is  personifying  his  environ- 
ment just  as  children  and  savages  do.  The  savage 
sees  malign  spirits  at  work  in  the  tree  against  which 
he  barks  his  shins  just  as  the  child  talks  in  anger 
to  the  chair  against  which  he  has  bumped  himself. 
This  is  the  animistic  stage  of  development  in  which 
the  individual  has  not  yet  adequately  separated  him- 


42  MENTAL  HYGIENE 

self  from  Ms  environment.  In  this  stage  of  de- 
velopment it  is  relatively  easy  to  project  one's  own 
difficulties  upon  the  environment  and  react  in  this 
way  and  thus  avoid  a  recognition  of  personal  short- 
comings— in  short  avoid  the  demands  of  reality. 
"Witness  the  billiard  player  who  blames  his  poor 
playing  upon  the  balls,  the  table,  the  cue,  in  short 
everything  but  his  own  lack  of  skill.  Such  a  person 
is  reacting  as  was  his  wont  when  a  child  to  react 
against  those  persons  in  his  environment  who  inter- 
fered with  his  pleasure  seeking.  If  we  will  stop  and 
think  we  will  realize  that  a  great  part  of  the  child's 
education  in  the  home  is  taken  up  with  being  told 
what  not  to  do.  He  is  being  constantly  interfered 
with  in  his  activities  and  these  activities  are  con- 
stantly being  repressed  as  bad,  as  naughty,  as  not 
nice,  etc.,  etc.  We  are  accustomed  to  seeing  the  child 
grow  irritable  and  restive  under  such  constant  re- 
pressions. The  type  of  reaction  I  have  described  is 
just  such  a  return  to  infantile  ways  of  reacting,  a 
return  under  the  stress  of  reality  to  a  more  familiar 
region,  a  region  which  gives  the  sense  of  at-home- 
ness.  Just  as  he  used  to  react  against  his  mother 
who  interfered  with  his  enjoyment  of  forbidden 
pleasures  so  now  the  billiard  player  reacts  against 
the  balls  and  the  cue.  As  the  mother  used  to  sym- 
bolize his  inability  to  get  pleasure  so  now  they 
symbolize  his  own  inadequacy  to  play  the  game  as 
well  as  he  wishes  to.  We  would  prefer  to  remain  in 
the  region  of  the  known,  the  familiar,  where  we  feel 


MENTAL  MECHANISMS  43 

safe.  Again  it  is  the  reaction  of  the  instinct  for  the 
familiar — the  safety  motive. 

During  infancy  and  adolescence  the  conflict  as- 
sumes a  somewhat  more  easily  recognizable  per- 
sonal quality,  and  takes  the  form  of  what  has  been 
called  the  family  romance.  In  this  period  the  child 
goes  through  a  series  of  love  experiences  which  are 
calculated  to  develop  him  along  those  lines  which 
will  make  him  ultimately  socially  efficient.  At  first, 
as  soon  as  he  has  learned  the  difference  between 
himself  and  those  about  him,  his  affection  is  natur- 
ally addressed  to  the  members  of  the  immediate 
household, — to  the  mother,  father,  brothers,  and  sis- 
ters, or  other  relatives,  and  the  nurse  who  may  con- 
stitute a  part  of  the  family.  These  are  the  people 
from  whom  he  gets  care  and  tenderness,  who  supply 
him  with  food,  minister  to  his  wants,  and  who  pro- 
tect him  in  every  way.  To  be  an  efficient  member  of 
society,  however,  he  has  to  emancipate  himself  from 
this  group  of  people,  he  has  to  be  able  to  transfer 
his  love  to  some  one  outside  of  the  family  and  found 
a  new  centre  himself.  This  severing  of  family  ties, 
casting  loose  from  the  parental  moorings  and  going 
forth  to  conquer  life  on  one 's  own  responsibilities  is 
one  of  the  most  painful  events  in  the  history  of  the 
individual  and  one  of  the  most  necessary,  and  even 
a  partial  failure  to  accomplish  this  result  brings  all 
sorts  of  trouble  in  later  years. 

What  is  meant  here  is,  of  course,  not  a  geographi- 
cal separation  but  a  separation  in  feeling  so  far  as 


44  MENTAL  HYGIENE 

feeling  spells  dependence,  infantilism.  The  excess- 
ive affection  which  holds  many  families  together  is 
often  purely  of  this  selfish  kind  seeking  only  per- 
sonal safety  and  not  the  independence  and  self- 
sufficiency  of  the  loved  one.^  Again  we  find  the  in- 
dividual resisting  the  demands  of  reality  that  would 
project  him  into  the  great  region  of  the  unknown, 
again  we  find  him  reacting  to  the  instinct  for  the 
familiar — the  safety  motive. 

THE    PATH    OF    OPPOSITES LOVE   AND   HATE 

That  idea  that  lies  closest  in  association  with  any 
other  idea  is  its  opposite.  The  idea  closest  in  our 
mind  to  the  idea  of  hot  is  cold,  to  long  is  short,  to 
fat  is  lean,  to  weak  is  strong,  etc.  This  tendency  to 
group  ideas  in  our  minds  in  accordance  with  this 
principle  of  opposites  is  a  fundamental  characteris- 
tic of  our  thought  processes,  probably  a  law  of 
thinking  which  has  grown  out  of  certain  necessities 
in  our  relations  with  our  surroundings.  For  ex- 
ample, if  it  was  always  bright  sunlight  the  idea  of 
brightness  would  never  have  to  be  formulated  as 
nothing  ever  happened  with  which  it  came  into  con- 
trast and  therefore  such  an  idea  would  have  no  use. 
But  the  night  follows  the  day  and  so  for  each  of 
these  portions  of  the  day  an  idea  arises  which  is  in 
contrast  to  the  other. 

This  contrast  is  well  shown  in  the  development  of 

1  For  a  full  discussion  of  the  family  romance  see  "Mechanisms  of 
Character  Formation." 


MENTAL  MECHANISMS  45 

language.  The  early  Egyptians  had  only  one  word 
for  strong  and  weak.  It  is  as  if  the  word,  so  to 
speak,  referred  to  the  whole  question  of  the  amount 
of  strength.  In  their  hieroglyphics  they  indicated 
its  more  specific  reference  by  the  addition  of  a  pic- 
ture of  an  erect,  vigorous  man  or  a  seated,  ex- 
hausted man.  Probably  in  speech  these  distinctions 
were  made  by  gestures. 

This  principle  of  the  path  of  opposites  is  appar- 
ently a  very  fundamental  one.  Much  might  be  writ- 
ten in  further  illustration  and  explanation  of  it.  I 
have  merely  set  it  forth  briefly,  we  will  meet  it  often 
in  our  experiences  with  people. 

Two  very  important  opposites,  in  fact,  perhaps 
the  most  important  and  the  most  fundamental,  are 
the  opposites  love  and  hate.  These  antithetic  emo- 
tions have  always  been  recognized  as  being  mysteri- 
ously closely  allied,  although  on  the  face  of  it  they 
have  nothing  in  common.  That  they  are  opposites 
is  the  key  to  their  close  relationship  and  the  ease 
with  which,  at  times,  one  may  replace  the  other. 
This  ambivalent  love-hate  type  of  reaction  is  very 
common,  very  important  in  its  pathological  manifes- 
tations. Love  is  always  the  expression  for  what 
is  constructive  in  the  individual,  hate  for  what  is 
destructive,  and  so  their  outward  manifestations  are 
of  great  importance  in  determining  which  way,  so 
to  speak,  the  individual  is  going,  whether  he  is  on 
the  forward  path  that  leads  to  life  or  the  backward 
path  that  leads  to  death. 

Love  and  hate  are  expressions  for  what  is  most 


46  MENTAL  HYGIENE 

fundamental  in  our  emotional  life,  and  because  love 
is  constructive  and  hate  destructive  it  is  equally 
fundamental  that  any  movement  calculated  for  the 
betterment  of  mankind  must  be  founded  upon  the 
one  and  eschew  the  other.  We  will  see  the  great 
value  of  this  distinction,  which  may  perhaps  seem 
rather  simple  and  axiomatic,  when  we  come  to  the 
special  problems  and  find  that,  in  spite  of  its  ap- 
parent self  evident  quality,  it  has  been  entirely  over- 
looked in  meeting  many  practical  issues.  We  shall 
be  able  to  trace  certain  types  of  failure  in  dealing 
with  the  socially  inadequate  to  just  this  failure  to 
appreciate  this  principle. 

I  will  follow  out  some  of  the  common  types  of  this 
love-hate  reaction  in  the  mechanism  known  as  pro- 
jection. 

PKOJECTION — THE   ANTIPATHIC   EMOTIONS 

I  have  already  given  examples  of  projection  in  the 
last  section — ^the  person  with  the  task  (to  write  a 
letter)  and  the  billiard  player.  These  types  of  re- 
action are  exceedingly  common  and  even  impress 
the  average  observer,  when  extreme,  as  childish. 
In  the  case  of  the  billiard  player  for  instance,  a 
moderate  amount  of  fussing  about  the  cue,  the  balls, 
etc.,  is  all  right.  Of  course  one  cue  is  better  than 
another  and  some  balls  are  better  than  others. 
When,  however,  such  a  player  keeps  up  a  constant 
stream  of  talk  all  through  the  game  of  bitter  sar- 
casm and  criticism  against  the  management  of  the 
Club,  for  instance,  the  care  of  the  tables,  the  neglect 


MENTAL  MECHANISMS  47 

of  every  one  to  do  their  duty,  when  he  broadens  the 
whole  criticism  out  to  include  people  in  general  and 
his  talk  degenerates  into  a  series  of  cynicisms  upon 
life,  the  government,  the  country,  when  the  slightest 
remark  or  even  the  failure  to  speak,  when  a  good 
shot  or  a  bad  one  equally  call  for  a  torrent  of  criti- 
cism of  everybody  and  everything,  the  reaction  is  at 
least  bordering  on  the  pathological  and  can  at  least 
be  appreciated  by  the  average  observer  as  certainly 
very  disagreeable  and  something  to  be  avoided. 
This  is  the  common  form  of  projecting  one's  own 
difficulties  upon  the  persons  and  things  about  them 
and  blaming  them.  It  is  the  old  method  of  the  child 
and  of  primitive  man,  and  not  so  primitive  after  all. 
During  the  Inquisition  not  only  were  animals  tried 
and  condemned  but  inanimate  objects  as  well,  and 
still  further  back  we  have  the  picture  of  Xerxes  hav- 
ing the  ocean  lashed  with  chains  for  wrecking  his 
ships. 

The  term  projection,  however,  is  technically  used 
for  a  somewhat  more  subtle  mechanism.  It  may  be 
simply  expressed  in  that  homely  observation  one 
hears  so  frequently  from  the  friends  of  the  mentally 
ill — that  *'the  insane  always  turn  upon  their  best 
friends."  Here,  of  course,  we  meet  again  the  love- 
hate  opposites,  but  why?  Suppose  a  business  man 
is  attracted  to  a  young  clerk  in  his  employ  and 
singles  him  out  for  special  favours,  gives  him  excep- 
tional opportunities,  in  short  puts  everything  in  his 
way  with  which  he  can  build  success.  Now  suppose 
that  this  clerk  is  a  failure  and  when  promoted  to  a 


48  MENTAL  HYGIENE 

high  position  of  trust  demonstrates  his  absolute  in- 
competency for  the  position.  How  does  the  busi- 
ness man  feel  towards  him?  He  feels  '^ disap- 
pointed in  him,"  and  somehow  this  feeling  of  dis- 
appointment seems  in  some  way  to  come  from  the 
young  man.  Now  suppose  the  clerk  had  not  only 
failed  but  had  falsified  the  accounts  and  robbed  his 
employer.  The  feeling  of  affection  which  the  em- 
ployer had  previously  had  for  his  clerk,  might  now 
easily  be  turned  into  its  ambivalent  opposite  hate, 
which  would  always  be  excited  when  he  came  into 
Ms  presence  or  was  called  upon  to  consider  him  in 
any  way.  Again  the  emotion  seems  to  depend  upon 
a  something  coming  from  the  hated  one. 

Of  course  this  kind  of  reaction  does  not  always 
take  place  but  when  it  does  it  is  because  the  love  was 
selfish  in  the  sense  already  described.  The  employ- 
er 's  love  was  not  directed  towards  making  the  young 
man  independent  of  him  but  dependent  upon  him 
because  he  took  pleasure  in  this  dependence. 
Therefore  the  disappointment  as  even  the  hate  is 
for  himself  as  symbolized  in  the  clerk.  That  it 
seems  to  come  from  him  is  a  distortion  to  escape  the 
unpleasant  realization  of  the  fact. 

All  these  mechanisms  are  simple  and  easy  to 
understand.  Now  suppose  that  one  person  has  an 
affection  for  another  without  quite  knowing  it,  in 
other  words,  without  its  being  clearly  conscious,  A 
woman,  for  example,  may  be  very  fond  of  a  young 
man  without  even  having  acknowledged  it  to  herself 
because  he  has  never  expressed  love  for  her.    Her 


MENTAL  MECHANISMS  49 

pride,  therefore,  would  not  permit  her  to  acknowl- 
edge a  love  that  was  not  returned.  Under  such  cir- 
cumstances the  absolutely  polite  and  considerate 
conduct  of  the  man  towards  her,  so  long  as  it  con- 
tains not  the  least  suggestion  of  love,  is  only  exas- 
perating to  the  last  degree.  The  woman  comes  to 
actually  hate  the  man,  she  could  ''tear  his  eyes  out," 
she  "can't  bear  to  have  him  around"  and  shows  by 
such  expressions  as  these  that  her  love  has  switched 
over,  temporarily  at  least,  to  its  ambivalent  opposite 
hate.  And,  too,  in  this  instance  the  hate  seems  to  be 
due  to  something  coming  from  the  man.  His  man- 
ner, his  way  of  dressing,  his  method  of  address  are 
all  hateful. 

This  example  gives  us  the  key  to  the  projection 
mechanism.  When  our  love  would  go  out  in  a  cer- 
tain direction  but  finds  its  path  blocked,  finds  itself 
up  against  a  stone  wall,  so  to  speak,  then  we  feel 
from  the  loved  object  only  pain.  This  pain  comes 
from  the  loved  object  and  so  prevents  a  realization 
that  the  trouble  is  within  and  not  without.  This  is 
the  mechanism  which  is  at  the  back  of  the  delusions 
of  persecution  so  common  in  the  psychoses.  But 
why  all  these  elaborate  mechanisms?  Why  is  it 
necessary  to  prevent  a  realization  that  the  trouble  is 
with  ourself  and  not  in  the  other  person? 

Whenever  it  has  been  possible  to  adequately  an- 
alyze one  of  these  hates,  such,  for  example,  as  are 
seen  in  the  delusions  of  persecution  of  paranoiacs 
where  instead  of  a  feeling  of  hate  there  is  a  feeling 
on  the  part  of  the  patient  of  some  malign  influence 


50  MENTAL  HYGIENE 

emanating  from  the  persecutor,  a  feeling  of  danger 
from  this  source,  whenever  it  has  been  possible  to 
analyze  such  a  situation,  it  has  been  found  that  the 
love,  which  is  felt  as  hate  coming  from  the  loved  one, 
has  a  quality  which  appeals  to  the  patient's  sense  of 
security.  In  other  words,  the  person  loved  is  loved 
not  in  the  normal  adult  way  that  makes  for  efficiency 
but  because  they  afford  a  sense  of  safety,  because 
they  have  money  or  power  and  can  protect,  because, 
perhaps,  they  resemble  the  parent  and  therefore  re- 
animate the  old  feeling  of  infantile  dependence. 
Thus,  it  will  be  seen,  such  hates  tend  to  drive  us 
away  from  sources  of  danger,  from  attachments 
that  would  prove  our  undoing.  It  is  again  our  old 
friend  the  instinct  for  the  familiar — the  safety  mo- 
tive. 

Projected  hate  or  the  feeling  of  persecution  can 
thus  be  seen  to  have  a  positive  function  to  perform. 
When,  under  such  circumstances  as  are  found  in 
the  examples  given,  we  are  tempted,  so  to  speak,  to 
lapse  from  an  efficient  dealing  with  reality  we  find 
an  artificial  barrier  erected  by  ourselves,  the  barrier 
of  hate  which  more  or  less  effectually  closes  the 
pathway  to  indolence,  inefficiency  and  destruction. 
To  remain  in  the  region  of  the  familiar,  not  to  ven- 
ture forth  where  no  trails  are  blazed,  is  all  too  easy 
and  all  our  psychological  reserves  must  be  brought 
to  the  front  if  the  day  is  to  be  saved.  There  are  no 
stronger  emotions  than  hate  and  fear,  so  these  are 
pressed  into  active  service.    We  hate  and  we  fear 


MENTAL  MECHANISMS  51 

the  very  things  we  desire  but  if  we  possessed  would 
destroy  us. 

The  clerk  who  gets  paranoid  ideas  towards  his 
employer  or  hates  him  wants  that  sort  of  return  for 
his  love  which  his  employer  can  not  give  him,  and  if 
he  could  would  be  so  much  the  worse.  He  wants  the 
sort  of  love  a  father  gives  a  child,  he  wants  protec- 
tion, special  consideration,  favours  and  assurances ; 
he  is  animated  by  the  safety  motive.  When  he  does 
not  get  these  his  love  is  turned  to  hate  and,  such  are 
the  subtleties  of  reactions  at  this  level,  he  then  not 
infrequently  does  his  work  well  in  the  spirit  of  ''I'll 
show  him"  and  so  is  kept  in  touch  with  reality  even 
at  the  moment  when  it  would  appear  the  fight  was 
lost.  The  antipathic  emotions  have  a  positive  and  a 
constructive  function. 

ANTAGONISM IDENTIFICATION 

The  antagonism  described  in  the  last  section  un- 
der the  head  of  the  projection  mechanism  is  seen  to 
be  an  antagonism  against  a  kind  of  love  which 
should  be  discarded  as  the  child  grows  to  adulthood. 
It  is  a  part  of  the  effort  to  gain  emancipation  from 
the  parents. 

We  find  a  somewhat  simpler  mechanism  when  the 
resistance  is  just  simply  the  resistance  against  real- 
ity as  represented  by  some  source  of  authority. 
The  child  never  objected  to  going  to  the  circus  with 
its  father,  it  was  the  request  to  chop  the  wood  that 
brought  forth  a  reaction  of  antagonism.    Later  in 


52  MENTAL  HYGIENE 

life  efforts  on  the  part  of  those  in  authority  meet 
with  like  reactions,  the  child  prefers  to  remain  in 
the  region  of  the  known — again  the  instinct  for  the 
familiar — the  safety  motive. 

Conversely  we  find  certain  people,  not  antagonis- 
tic, not  hostile  towards  the  love  object  but,  and  this 
is  a  widespread  type  of  reaction,  tending  to  identify 
themselves  with  it.  Of  course  here  are  the  familiar 
instances  of  the  boy  who  wants  to  grow  up  to  be  like 
father,  the  girl  to  be  like  mother,  and  quite  as  clearly 
those  who  form  some  attachment  outside  the  family, 
a  teacher,  employer,  a  noted  person  who  is  taken  as 
a  model.  The  desirability  of  the  result  depends  a 
good  deal,  naturally,  upon  the  model  chosen,  whether 
it  be  a  respectable  citizen  or  a  highwayman.  It  is 
also  very  important  just  how  the  identification  is 
worked  out,  whether  the  model  is  an  ideal  and  leads 
to  the  best  aspirational  efforts  or  whether  the  iden- 
tification is  only  used  to  reinforce  the  safety  motive 
for  conduct. 

The  identification  with  the  love  object  when  that 
love  object  is  desired,  not  as  an  ideal  but  as  a  means 
of  safety  and  protection,  is  one  of  the  ways  in  which 
the  love  object  is  appropriated  in  thought,  one  of  the 
ways  in  which  security  is  sought  by  thinking  (phan- 
tasying)  rather  than  by  action.  Many  neurotic  and 
psychotic  patients,  for  example,  reproduce  quite  ac- 
curately the  peculiarities,  even  to  the  illnesses,  of  a 
parent.^    Not  infrequently  the  identification  is  with 

2  This  has  usually  been  explained  as  due  to  heredity  which,  of 
course  it  may  be,  but  it  not  infrequently  is  a  psychological  reaction 


MENTAL  MECHANISMS  53 

the  patient's  own  infantile  self  as  in  those  cases  that 
persist  in  certain  habits  of  eating  as,  for  instance, 
only  eating  those  foods  to  which  they  had  been  ac- 
customed as  children  in  the  home.  Again  the  in- 
stinct for  the  familiar — the  safety  motive. 

CONVEESION 

In  general  the  difficulties  at  the  psychological  level 
arise  because  of  inability  to  deal  effectively  with 
reality,  and  in  being  forced  back  from  an  effective 
adjustment  to  reality  the  individual  is  pushed  back- 
wards to  earlier  instinctive  levels  of  activity  which 
are  more  familiar,  to  regions  in  which  he  feels  a 
greater  sense  of  security.  Inasmuch  as  the  psycho- 
logical integrations  are  made  possible  only  because 
of  the  physiological  integrations,  which  have  pre- 
ceded them  in  the  course  of  evolution  and  develop- 
ment, it  must  happen  that,  if  the  push  back  from 
reality  is  very  great  and  long  continued  that  those 
lower,  bodily  types  of  integration  must  often  suffer. 
The  mental  conflict  is  outwardly  expressed  by  dis- 
turbances of  bodily  function.  Psychological  con- 
flict is  converted  into  bodily  disorder.  This  is  what 
is  implied  by  the  term  conversion  and  is  the  charac- 
teristic mechanism  of  hysteria. 

We  are  all  familiar  with  those  cases  of  hysterical 

(symbolization)  pure  and  simple.  To  always  explain  on  the  heredi- 
tary hypothesis  would  be  a  poor  way  to  approach  the  problem  thera- 
peutically and  in  any  case  it  must  often  be  impossible  to  predicate 
heredity  until  at  least  an  effort  is  made  to  deal  with  the  situation 
at  the  psychological,  modifiable  level. 


54  MENTAL  HYGIENE 

paralysis  in  which  an  arm  or  a  leg  may  be  quite  use- 
less for  months  and  which  not  infrequently  is  "mir- 
aculously" made  to  disappear  over  night,  often  to 
the  chagrin  of  the  attending  physician,  by  some 
extra-professional  "cure."  The  meaning  of  such 
cases  can  be  seen  in  such  an  instance  as  that  cited 
by  Pfister.^  A  young  man  of  seventeen  notices  a 
queer  feeling  in  his  left  arm  contemporaneous  with 
a  desire  upon  the  part  of  his  father  to  transfer  him 
to  a  school  to  which  he  does  not  wish  to  go.  Analy- 
sis revealed  the  fact  that  when  a  child  he  struggled 
so  violently  against  being  vaccinated  that  it  had  to 
be  given  up.  Translated  into  terms  of  his  present 
difficulty  it  means  that  since  as  a  child  he  had  suc- 
ceeded in  avoiding  something  disagreeable  by  his 
stubborn  resistance,  he  wishes  again  to  avoid  some- 
thing disagreeable  in  the  same  way.  He  tends,  when 
presented  with  a  reality  situation  to  which  he  can- 
not bring  himself  to  make  an  adequate  adjustment, 
to  revert,  unconsciously  of  course,  to  a  familiar  type 
of  reaction  which  had  succeeded  before  in  saving 
him  from  a  disagreeable  adjustment — the  instinct 
for  the  familiar — the  safety  motive. 

These  hysterical  conversions  are  used  in  all  sorts 
of  ways  and  serve  many  purposes.  Ames  reports 
a  case  of  hysterical  blindness  *  in  a  man  which  was 
the  result  of  a  long  period  of  incompatibility  with 

3  "The  Psychoanalytic  Method."  Moflfat-Yard  &  Co.,  New  York, 
1917. 

*T.  H.  Ames:  "Blindness  as  a  Wish,"  The  Psychoanalytic  Review, 
Vol.  I,  No.  I,  November,  1913. 


MENTAL  MECHANISMS  55 

his  wife  and  expressed  the  desire  on  his  part  not  to 
see  her  any  more.  Many  hysterics  develop  bodily 
symptoms  of  illness  in  order  to  get  that  solicitous 
attention  and  consideration  which,  often  because  of 
their  lack  of  lovable  qualities,  they  could  not  other- 
wise obtain.  They  seek  safety  in  childish  reactions. 
Acting  like  children  they  are  cared  for  and  treated 
as  children. 

The  conversion  mechanism  also  serves  more  com- 
plex ends.  A  woman  sues  a  railroad  corporation 
for  injuries  received  in  an  accident  and  collects  a 
large  verdict.  Contrary  to  the  supposed  rule  she 
does  not  get  immediately  well  after  the  case  is  set- 
tled. She  goes  from  one  physician  to  another  com- 
plaining of  pain  until  she  finally  succeeds  in  induc- 
ing a  surgeon  to  operate  upon  her.  The  operation 
revealed  a  perfectly  normal  state  of  affairs  but  after 
it  the  patient  got  promptly  well.  All  the  while  she 
knew  in  the  back  of  her  head  that  she  had  not  been 
injured  and  was  not  entitled  to  the  money.  The 
operation  is  a  penance  for  her  guilt.  She  wants  the 
devil  cast  out  (in  this  instance  cut  out)  of  her.  The 
penance  motive  is  very  deep  seated  in  man,  we 
meet  it  over  and  over  again  in  his  various  religions 
and  in  this  case  we  see  the  hysterical  conversion 
serving  this  motive.  The  patient  feels  the  neces- 
sity, unconsciously  of  course,  of  suffering  injury  in 
order  to  justify  herself  for  taking  the  money.  She 
seeks  for  a  return  of  her  old  self  with  its  sense  of 
security  before  she  ventured  on  the  dangerous  path 


56  MENTAL  HYGIENE 

of  deceit.    It  is  the  instinct  for  the  familiar — the 
safety  motive. 

The  number  and  duration  of  physical  and  ap- 
parently physical  disorders  which  may  originate  at 
the  psychological  level  is  endless.^  It  includes  many 
forms  of  asthma,  sore  throat,  difficult  nasal  breath- 
ing, stammering,  headache,  neurasthenia,  backache, 
tender  spine,  'Veak  heart,"  faint  attacks,  exoph- 
thalmic goitre  (Grave's  or  Basedow's  disease), 
aphonia,  spasmodic  sneezing,  hiccough,  rapid  res- 
piration, hay  fever,  gastro-intestinal  disturbances 
(constipation,  diarrhoea,  indigestion,  colitis,  ulcer 
of  stomach),  ptosis  of  kidney,  diabetes,  disturbances 
of  urination  (polyuria,  incontinence,  precipitancy), 
menstrual  disorders,  autointoxication  (from  long 
continued  digestive  disturbance),  nutritional  dis- 
orders of  skin,  teeth,  and  hair,  etc.,  etc.  This  list 
will  give  some  idea  of  how  frequent  these  disturb- 
ances are,  how  they  affect  all  organs  of  the  body,  and 
so  invade  all  departments  of  medicine. 

OTHEE  DEFENCE   MECHANISMS 

All  of  the  various  mechanisms  I  have  described 
belong  to  what  may  be  called  defence  mechanisms. 
They  have  as  their  purpose,  among  other  things, 
defending  the  individual  from  a  knowledge  of  his 

5  For  recent  literature  see  G.  Hudson-Makuen,  Presidential  Ad- 
dress, American  Laryngological  Association,  Isl.  Y.  Med.  Jour.,  Nov. 
4,  1916;  Guthrie  Rankin:  "The  Highly  Strung  Nervous  System," 
Br.  Med.  Jour.,  Oct.  21,  1916;  Crile:  "Man — An  Adaptive  Mechan- 
ism," N.  Y.,  1916,  The  Macmillan  Co. 


MENTAL  MECHANISMS  57 

own  shortcomings,  his  own  deficiencies.  They  are 
all  efforts,  ineffectual  efforts  and  therefore  forms  of 
compromise  and  compensation,  to  escape  the  ade- 
quate, straightforward  and  necessary  way  of  deal- 
ing with  reality  if  it  is  to  be  effectually  handled. 

A  murderer  killed  a  man  by  stabbing.  I  ques- 
tioned him  in  order  to  see  how  he  felt  about  his  act 
and  his  sentence  to  life  imprisonment.  In  the  first 
place  he  was  very  emphatic  in  his  blame  of  the  de- 
ceased for  picking  a  quarrel  with  him.  He  was  very 
much  larger  than  the  prisoner  and  so  the  only  way 
in  which  he  (the  prisoner)  could  adequately  defend 
himself  was  with  some  weapon.  The  deceased  knew 
this  and  was  virtually  taking  his  life  in  his  hands 
when  he  started  the  trouble.  Then  again  the  doc- 
tor did  not  treat  the  wound  as  he  should  have.  The 
man,  therefore,  really  came  to  his  death  through  his 
own  foolhardiness  and  the  lack  of  skill  of  the  phy- 
sician. This  was  all  told  with  a  smiling  countenance 
and  without  the  remotest  suggestion  that  the  pris- 
oner blamed  himself  in  the  least.  This  is  the  re- 
action of  justification  by  the  process  of  rationalisa- 
tion. 

The  alcoholic  justifies  his  indulgence  by  just  such 
rationalizations.  He  drinks  because  it  is  hot  or  be- 
cause it  is  cold,  because  he  cannot  refuse  a  friend, 
or  one  drink  won't  hurt  him,  or  he  did  not  really 
mean  to  drink  that  evening  at  all,  or  a  thousand 
other  ''sophisms  of  the  indolent"  to  protect  him 
from  a  realization  that  he  is  not  equal  to  the  effort 
of  refusal  or  resistance. 


58  MENTAL  HYGIENE 

The  man  who  is  failing  in  mental  efficiency  be- 
lieves that  other  members  of  the  office  force  are 
putting  up  jobs  on  him,  annoying  him,  interfering 
with  him  in  all  sorts  of  ways  so  he  cannot  do  his 
work.  He  projects  his  failing  efficiency  upon  others 
and  saves  himself  from  realizing  it. 

A  disagreeable  task  has  to  be  performed  at  a 
certain  time — it  is  forgotten  or  a  headache  is  de- 
veloped as  an  excuse  for  its  avoidance. 

A  man  is  guilty  of  cheating  his  closest  friends  out 
of  some  considerable  money.  He  cannot  look  his 
friends  in  the  face.  To  escape  a  realization  that  he 
is  ashamed  of  his  conduct  because  he  is  guilty,  he 
develops  a  defect  of  vision  and  has  to  go  about  with 
smoked  glasses  and  shaded  eyes. 

An  automobilist  runs  over  some  one  and  speeds 
up  his  machine  and  runs  away  without  looking  back, 
trying  to  make  himself  think  he  did  not  see  the  acci- 
dent, therefore  knows  nothing  about  it,  therefore  it 
did  not  happen. 

A  profoundly  depressed  woman  dreams  of  being 
at  home,  happy  with  her  children  and  so  is  com- 
pensated, to  some  extent,  for  her  depression. 

Persons  of  rather  defective  type  of  personality 
ape  the  mannerisms  and  peculiarities  of  dress  of 
prominent  people  and  thus  bolster  up  their  self  es- 
teem. 

The  list  is  endless,  defence,  compromise,  compen- 
sation, adjustment,  the  mechanisms  are  few  but  the 
limits  of  their  use  are  as  many  as  the  individuals 


MENTAL  MECHANISMS  59 

themselves.^  Throughout  them  all,  however,  we  see 
in  operation  the  instinct  for  the  familiar — the  safety 
motive. 

It  is  hoped  that  this  brief  survey  of  some  of  the 
more  important  of  the  mental  mechanisms  will  en- 
able the  reader  to  see  more  clearly  when  he  comes 
to  the  problems  that  we  must  now  turn  to. 

6  For  a  more  profound  discussion  of  the  various  mechanisms  see 
"Mechanisms  of  Character  Formation." 


CHAPTEE  rV 
THE  INSANE 

THE   WORD   INSANE 

In  the  first  place,  before  we  can  intelligently  ap- 
proach the  problem  indicated  by  the  heading  of  this 
chapter  it  will  be  necessary  to  correct  an  almost 
universal  misapprehension  as  to  the  meaning  of  the 
word  insane.  The  wrong  use  of  this  word  is  respon- 
sible for  really  grievous  errors  and  must  be  cor- 
rected if  it  is  to  be  possible  to  deal  with  the  ques- 
tions included  in  this  concept  with  intelligence. 

The  word  insane  has  been  applied  loosely  for  a 
long  time  to  those  patients  who  were  to  be  found  in 
the  large  asylums  and  hospitals  for  the  insane  and  to 
persons  in  the  community  who  acted  so  strangely  as 
to  set  them  apart  from  other  people.  The  word  has 
never  had,  in  its  popular  use,  a  more  definite  mean- 
ing than  this.  The  only  important  effort  to  clearly 
define  what  was  meant  by  insane  has  been  made  by 
the  law.  Here  even  we  do  not  find  any  very  under- 
standable attempt  if  we  read  the  statutes  but  we  do 
find  a  perfectly  well  defined  method  of  procedure  to 
determine  whether  a  given  individual  conforms  to 
the  definition  laid  down  or  not.  This  method  is  the 
method  of  trial  before  a  jury  and  the  verdict  of  the 
jury  decides  the  issue.     On  the  face  of  it  this  seems 

60 


THE  INSANE  61 

an  absolutely  absurd  proposition,  especially  when 
we  find  that  the  statute  defines  an  '^ insane  person" 
as  a  person  of  ''unsound  mind"  thus  merely  substi- 
tuting one  term  for  another.  Any  one  at  all  familiar 
with  mental  disease  knows  that  there  are  many 
forms  of  mental  illness,  and  to  group  them  all  under 
one  term — ^insanity — gives  us  hardly  any  more  in- 
formation than  to  say  they  are  all  sick,  and  cer- 
tainly no  more  information  than  we  would  have  of  a 
sick  person  if  we  inquired  what  the  matter  was  with 
him  and  were  told  that  he  had  a  cough.  In  the  lat- 
ter case  the  patient  might  have  a  cold,  bronchitis, 
laryngitis,  pneumonia,  pulmonary  tuberculosis,  heart 
disease,  asthma,  and  I  am  sure  I  do  not  know  how 
many  more  things — in  the  former  case  the  informa- 
tion would  be  quite  as  indefinite. 

It  is  perfectly  clear,  therefore,  that  the  jury  can 
have  no  intelligent  understanding  of  what  they  are 
doing  in  the  light  of  present-day  scientific  standards. 
What  is  the  meaning  of  their  action  then?  If  the 
jury  is  conceived  as  society  in  miniature  then  their 
verdict  is  the  verdict  of  society,  which  means  that 
society  has  decided  to  label  such  and  such  an  indi- 
vidual as  ''insane"  in  the  same  arbitrary  way  that 
it  does  other  things,  attaches  other  labels,  as  for 
example  the  label  of  majority  (age  twenty-one),  the 
age  of  consent,  the  label  of  grand  larceny  as  distin- 
guished from  petit  larceny  (based  on  value  stolen), 
the  label  of  legislator,  judge,  etc.,  etc.  From  the 
previous  discussion  it  is  easy  to  see  that  the  jury  is 
acting,  not  with  clear  conscious  intent  but  instinc- 


62  MENTAL  HYGIENE 

tively,  reflecting  the  attitude  of  the  herd,  which  in 
this  instance  is  to  regard  the  individual  as  sick,  as 
irresponsible,  and  so  to  treat  him  kindly  and  take 
such  care  of  him  as  may  result  in  his  getting  well. 
Of  course  I  am  referring  only  to  the  more  advanced 
communities,  I  am  painfully  aware  that  this  is  very 
much  more  than  can  be  read  into  the  verdict  in  all 
too  many  places. 

To  know  that  a  person  has  been  *  labelled'*  insane 
by  ''due  process  of  law,"  therefore,  tells  us  practi- 
cally nothing  about  that  individual  except  that  the 
herd,  as  represented  by  the  jury,  having  noted  his 
being  so  different  from  the  average  individual, 
has  concluded  to  label  him ' '  insane ' '  and  send  him  to 
a  public  institution  for  the  care  of  the  "insane." 
Insanity  therefore  means  nothing  more  nor  less  than 
commitable  or,  better,  certifiable. 

Can  we  get  any  better  idea  of  the  characteristics 
of  this  group  labelled  ''insane"? 

If  one  will  think  of  a  primitive  community  out  in 
the  Middle  West  during  the  times  when  the  Middle 
West  was  yet  the  frontier,  one  will  realize  that  a 
member  of  that  relatively  primitive  community 
could,  if  one  will  think  of  Mark  Twain's  descrip- 
tions, ride  down  the  centre  of  the  street  and  yell  and 
holler  and  shoot,  and  it  was  thought  to  be  a  com- 
paratively normal  kind  of  conduct  and  nobody 
thought  it  was  strange  and  nobody  interfered  with 
it.  Now  when  communities  get  to  be  older  and  more 
civilized,  when  they  get  to  be  more  congested,  one 
cannot  do  anything  that  he  may  happen  to  choose, 


THE  INSANE  63 

without,  perhaps,  crossing  the  path  of  someone  else. 
Then  certain  conventions  of  conduct  have  to  be  fol- 
lowed and  there  have  to  be  greatly  restricted  lines 
of  conduct,  so  that  if  a  man  acted  as  I  have  de- 
scribed, he  knows  just  where  he  would  land.  It 
might  be  and  probably  would  be,  in  the  jail.  In 
other  words,  he  is  exhibiting  a  certain  type  of  con- 
duct which  the  community — to  speak  in  slang  phrase 
— won't  stand  for,  and  they  simply  remove  him 
from  it. 

In  the  group  of  people  that  are  called  ''insane" 
are  people  who  exhibit  certain  types  of  conduct 
which  cannot  be  tolerated  in  the  community  in  which 
they  happen  to  live.  I  remember  some  time  ago,  in 
walking  down  to  my  quarters  at  the  hospital,  a 
woman  threw  up  the  window,  thrust  her  head  out 
and  shouted,  ''Murder!"  Nobody  paid  any  atten- 
tion whatever  to  her.  We  were  used  to  that  sort  of 
thing.  She  shut  the  window  down,  and  went  back 
to  bed.  She  was  in  a  community  where  she  was  un- 
derstood. But  she  could  not  do  that  sort  of  thing 
anywhere  outside  of  an  institution  without  being 
shut  up  for  "insanity."  And  so  it  is  that  an  indi- 
vidual must  conform  to  the  established  usages  of  the 
society  in  which  he  lives. 

Now  what  is  the  characteristic  of  these  types  of 
conduct?  It  is  social  inadequacy.  The  individual 
who  manifests  a  kind  of  conduct  that  is  calculated  to 
tear  down  the  existing  conventions,  to  deviate 
greatly  from  the  normal  conduct  of  the  community 
— that    person   is    an   individual   who   has    to   be 


64  MENTAL  HYGIENE 

relegated  to  some  place  other  than  a  position  of  free 
citizenship.  Thus  certain  types  of  socially  ineffi- 
cient conduct  may  be  said  to  be  ''insane"  conduct, 
and  so  the  word  ''insanity"  comes  to  be,  as  I  see  it, 
not  a  medical  term  at  all,  but  a  social  term  which 
defines  certain  kinds  of  socially  inefficient  conduct. 

Let  me  elaborate  a  little  further  what  I  mean  by 
conduct.  You  or  I  or  any  one  else  can  think  all  we 
want  to  about  threatening  some  one's  life;  we  can 
formulate  all  sorts  of  plans  about  meeting  him  and 
shooting  him,  as  long  as  we  do  not  say  anything  about 
it  or  do  not  do  anything  about  it.  But  let  us  for  a 
moment  start  to  put  such  a  plan  into  execution,  and 
that  moment  something  will  happen  to  us.  In  other 
words,  we  may  have  any  sort  of  desire,  our  thinking 
apparatus  may  function  in  any  one  of  a  great  num- 
ber of  ways,  but  so  long  as  it  does  not  manifest  itself 
in  our  outward  conduct  in  any  way,  society  has 
no  interest  in  it.  So  then,  I  would  say  that  "in- 
sanity" includes  certain  types  of  socially  inefficient 
conduct,  certain  kinds  of  socially  inefficient  conduct 
that  cause  trouble  in  the  community. 

To  gather  up  the  threads — "insanity"  is  not  a 
medical  term  at  all  but  a  social  and  legal  term:  it 
does  not  refer  primarily  to  mental  disease  but  to 
conduct :  the  types  of  conduct  to  which  it  refers  are 
socially  inadequate  conduct  but  only  of  such  kinds 
and  degrees  as  are  incompatible  with  life  in  the  com- 
munity of  which  the  individual  is  a  member :  and  fur- 
ther they  are  such  types  of  conduct  which  the  herd 


THE  INSANE  65 

looks  upon  as  evidence  of  disease  and  as  implying 
irresponsibility  and  therefore  leniency. 

While  "insane"  conduct  is,  therefore,  the  result 
of  mental  disease,  ''insanity"  and  mental  disease 
are  not  interchangeable  terms.  While  all  the  in- 
sane are  theoretically  mentally  ill  (a  person  ad- 
judicated as  insane  is  nevertheless  insane  even 
though  it  be  found  out  afterwards  that  a  mistake 
had  been  made)  not  all  the  mentally  ill  by  any 
means  are  insane  in  the  sense  of  having  been  ad- 
judicated or  even  in  the  sense  of  certifiable,  that  is, 
could  be  adjudicated.  Mental  illness  is  a  broad 
concept  that  may  well  include  many  highly  efficient 
and  valuable  members  of  the  community.  It  is, 
therefore,  only  certain  kinds  and  degrees  of  mental 
illness  which  may  be  classified  socially  and  legally 
as  ' '  insanity. ' ' 

And  finally,  that  feature  of  the  conduct  which 
makes  the  herd  look  leniently  upon  it  is  of  great 
importance  as  we  shall  see  when  we  come  to  con- 
sider those  varieties  of  conduct  upon  which  the  herd 
looks  very  differently,  namely,  the  criminal. 

The  insane,  therefore,  to  use  the  word  as  I  have 
defined  it,  will  be  seen  to  be  constituted  of  a  hetero- 
geneous mixture  of  types,  the  only  common  charac- 
teristic of  which  is  that  they  have  been  labelled  and 
that  they  present  a  series  of  conduct  disorders,  due 
to  a  multitude  of  various  mental  diseases,  that  ren- 
der their  orderly  living  in  a  community  and  consti- 
tuting useful  members  thereof  impossible.     They 


66  MENTAL  HYGIENE 

are  segregated  and  put  apart  from  the  rest  of  the 
herd  because  they  are  points  of  lost  motion  which 
interfere  with  the  efficient  running  of  the  social 
machine.  The  disorder  is  a  disorder  of  the  in- 
dividual-society relation.  From  now  on  I  shall 
avoid  the  use  of  the  word  insane,  except  as  being 
synonymous  with  certifiable,  and  use  instead  such 
terms  as  mental  disease  and  psychosis. 

HISTORICAIi 

This  book  is  not,  by  any  means,  intended  to  take 
up  all  of  the  multitudinous  issues  that  present  for 
consideration  in  relation  to  the  dependent,  defective 
and  delinquent  classes.  It  has  no  such  object.  Its 
object  is  quite  different ;  it  is  to  effect  a  new  orien- 
tation towards  these  problems  more  especially  from 
the  viewpoint  of  preventive  medicine  rather  than 
from  such  viewpoints  as  the  economic  or  the  admin- 
istrative, for  example.  Historical  matters  will, 
therefore,  only  be  touched  upon  to  the  extent  that 
they  may  throw  light  upon  this  particular  pathway. 

As  is  well  known,  in  the  early  days,  in  the  Mid- 
dle Ages,  and  among  peoples  at  lower  cultural  levels 
than  ourselves  the  so-called  insane  have  been  re- 
garded usually  from  one  of  two  opposite  stand- 
points, either  as  being  inspired,  or  as  being 
possessed  of  the  devil.  Unfortunately  the  latter 
viewpoint  has  been  taken  much  the  more  frequently, 
and  the  result  has  been  disastrous  for  the  poor,  sick 
individual. 

Even  in  later  times,  the  latter  part  of  the  18th  cen- 


THE  INSANE  67 

tury  and  the  fore  part  of  the  19th  century,  while  the 
insane  person  was  often  not  specifically  thought  to 
be  possessed  of  the  devil,  literally  speaking,  yet  he 
was  treated  very  much  as  if  he  were.  The  literal  ap- 
plication of  the  doctrine  of  diabolical  possession  may 
have  and  did  go  out  of  existence,  at  least  in  many 
places,  but  there  remained  a  certain  attitude  toward 
those  of  diseased  mind  which  was  not  very  different 
from  that  born  of  this  horrid  superstition.  The 
mentally  diseased  were  considered,  just  as  they  had 
been  under  the  influence  of  the  superstition,  to  be 
beings  apart  from  others;  "craziness"  was  a  condi- 
tion which  was  not  capable  of  being  understood,  and 
which  had  the  practical  effect  of  isolating  and  os- 
tracizing those  who  suffered  from  it.  Along  with 
this  attitude,  borne  of  ignorance,  there  naturally 
went  the  twin  brother  of  ignorance, — fear, — for 
wherever  there  is  a  lack  of  understanding,  wherever 
phenomena  are  enveloped  in  mystery,  wherever  the 
source  of  events  is  unknown,  there  we  always  find 
fear.  Ignorance  and  fear  then,  have  been  the  great 
obstacles  that  have  had  to  be  overcome  in  dealing 
with  the  problems  of  the  care  and  the  treatment  of 
the  mentally  diseased,  and  they  are  problems  which 
have  been  overcome  only  partly  and  only  here  and 
there,  because  they  are  defects  within  ourselves,  and 
therefore  it  is  only  with  the  extreme  st  difficulty 
that  we  are  able  to  appreciate  them  and  even  then 
probably  not  at  their  full  value.  The  patients  them- 
selves, however,  through  the  ages,  have  been  cry- 
ing out  to  be  understood,  and  it  is  only  in  the  most 


68  MENTAL  HYGIENE 

recent  times,  since  the  mental  mechanisms,  some  of 
which  I  have  described  in  the  last  chapter,  have  been 
worked  out,  that  we  have  been  able  to  turn  an  un- 
derstanding ear  to  what  they  had  to  say. 

In  the  midst  of  all  the  horror  and  the  degrada- 
tion with  which  the  care  of  the  insane  has  been 
surrounded  as  a  result  of  ignorance  and  fear  there 
have  always  stood  forth  commanding  personalities 
who  have  preached  the  gospel  of  love  and  have  en- 
deavoured by  the  force  of  their  noble  example  to 
introduce  a  spirit  of  kindliness  and  humanitarianism 
into  the  work.  Such  men,  for  example,  were  Celsus, 
who  nearly  two  thousand  years  ago  advocated  quiet 
walks  in  beautiful  gardens,  music,  hydrotherapy, 
reading,  meditation,  in  the  treatment  of  mental  dis- 
ease; Pin  el  (1745-1826)  who  in  the  latter  part  of  the 
18th  century,  struck  the  chains  from  the  unfortu- 
nate inmates  of  the  Paris  hospitals;  Reil^  (1759- 
1813),  whose  work  on  the  treatment  of  mental  dis- 
eases might  be  read  with  profit  to-day,  and  later,  in 
our  own  times  and  within  comparatively  recent 
years,  Dorthea  L.  Dix  (1802-1887),  whose  name  is 
intimately  connected  with  so  many  hospitals  for  the 
care  of  this  class  of  patients  in  the  United  States, 
and  later  still,  Beers,^  through  whose  activities  the 
National  Committee  for  Mental  Hygiene  came  into 
existence. 

1  See  the  author's  "Reil's  Ehapsodieen,"  Jour.  Nerv.  and  Ment. 
Dis.,  January,  1916. 

aCliflFord  W.  Beers:  "A  Mind  that  Found  Itself,  An  Autobiog- 
raphy."   New  York,  1913. 


THE  INSANE  69 

As  a  result  of  humanitarian  endeavour  the  care 
of  the  insane  emerged  from  the  dark  ages,  controlled 
by  superstition,  into  the  philanthropic  period.  The 
history  of  this  movement  in  this  country,  began 
about  a  hundred  years  ago.  The  idea  of  kindness 
was  brought  from  England  largely  by  the  Quakers, 
who  first  gave  concrete  expression  to  their  view  in 
the  institutions  in  Pennsylvania,  and  this  idea 
spread  and  brought  to  its  standard  many  men  and 
women  of  noble,  self-sacrificing  character,  and 
there  grew  out  of  it  the  doctrine  of  non-restraint 
which  has  been  so  splendidly  put  into  operation  by 
such  men  as  Page,  in  Massachusetts,  and  there  fur- 
ther grew  out  of  it  the  idea  of  treatment  by  indus- 
trial occupation  which  is  used  to  such  good  advan- 
tage in  so  many  institutions  at  the  present  time. 

All  these  developments  were  useful  and  served 
valuable  ends,  but  they  were  not  satisfying.  It  was 
still  felt,  even  after  the  development  had  proceeded 
along  all  these  lines  and  reached  a  fair  degree  of 
perfection,  that  after  all  the  great  hospitals  for  the 
care  of  the  mentally  diseased  were  largely  boarding 
houses  where  groups  of  people  who  were  inefficient 
and  could  not  get  along  in  the  social  milieu  were 
brought  and  housed,  treated  kindly,  to  be  sure,  and 
given  opportunity  for  occupation  to  while  away 
otherwise  idle  hours,  but  that  aside  from  removing 
them,  particularly  in  acute  conditions,  from  the  cir- 
cumstances in  which  and  about  which  their  disorder 
developed,  aside  from  this  one  thing,  with  of  course 
good  feeding  and  housing,  aside  from  this,  there 


70  MENTAL  HYGIENE 

was  very  little,  practically  nothing  done  in  the  way 
of  actual  treatment. 

The  most  significant  attempt  to  definitely  intro- 
duce the  therapeutic  idea  into  these  hospitals  was 
made  through  an  effort  to  conduct  them  after  the 
same  manner  as  the  general  hospitals.  Patients 
were  received  and  placed  in  bed,  trained  nurses 
were  provided  for  their  care,  and  most  careful  ex- 
aminations and  observations  were  made,  tempera- 
ture, pulse,  respiration  were  recorded,  the  physical 
examinations  of  the  internal  organs  were  carefully 
gone  into,  and  every  attempt  was  made  to  discover 
any  physical  illness  which  might  be  present  and  to 
care  for  the  physical  health  on  the  theory  that  in 
some  way  the  mental  state  was  dependent  upon  it. 
This  general  hospital  idea  had  much  to  commend 
it,  much  indeed  which  was  not  conceived  of  by  those 
who  originated  it.  The  training  schools  for  nurses 
are  the  outgrowth  of  this  idea,  and  in  its  operation 
it  brought  to  the  care  of  the  mentally  diseased  pa- 
tient a  higher  grade  of  care-taker  and  one  who  the 
hospital  made  considerable  effort  to  specially  equip 
for  the  work.  The  trained  nurse  as  a  graduate 
of  the  hospital  training  school  was  therefore  more 
efficient  and  more  intelligent,  and  the  patient  bene- 
fitted accordingly. 

Still  with  all  this,  and  with  all  the  improvements 
which  resulted  there  was  still  dissatisfaction,  for 
after  all,  the  actual  problem,  the  treatment  of  the 
mental  disease  itself,  not  as  an  outgrowth,  an  ad- 
junct, or  a  dependency  of  some  physical  trouble, 


THE  INSANE  71 

but  as  a  thing  in  itself,  as  it  usually  is,  the  actual 
treatment  of  the  mental  disease  per  se  was  not  really- 
touched.  Kindliness  was  the  order  of  the  day,  was 
the  ideal  towards  which  every  one  who  entered  into 
the  work  was  made  to  look;  greater  intelligence 
permeated  the  entire  situation,  and  yet,  and  here  is 
the  significant  thing,  not  greater  intelligence  about 
the  actual  mental  disease  itself.  Very  little  in  all 
this  time  had  actually  been  learned  about  what 
mental  disease  really  meant.  It  was  still  about  as 
much  of  a  mystery  as  it  had  been  when  it  was  super- 
stitiously  regarded  as  the  result  of  divine  inspira- 
tion or  diabolical  possession.  Such  superstition, 
to  be  true,  had  left  the  stage  and  left  forever,  but 
nothing  had  effectively  taken  its  place.  With  the 
exception  of  a  few  conditions  dependent  upon  gross 
injury  or  disease  of  the  brain,  we  were  in  as  much 
darkness  regarding  the  underlying  factors  of  dis- 
ease as  had  been  our  predecessors  of  generations  be- 
fore. '^Craziness"  was  for  the  most  part  still  just 
'^craziness,"  and  while  ignorance  and  fear  had  been 
robbed  of  the  props  of  superstition,  they  were  still 
very  much  in  evidence  on  their  own  account. 

Perhaps  throughout  this  stage  of  development 
that  I  have  been  tracing,  this  stage  of  transition, 
from  the  period  of  superstition  to  that  of  philan- 
thropy, in  which  the  ideal, — kindness, — was  the  goal 
toward  which  every  effort  was  directed,  the  most 
constant  matter  for  controversy  was  the  doctrine  of 
non-restraint.  There  seemed  to  be  a  constant  tend- 
ency of  the  whole  question  of  the  care  and  treatment 


72  MENTAL  HYGIENE 

of  the  mentally  diseased  to  revolve  about  this  prob- 
lem, and  yet  the  amount  of  change  which  was  gradu- 
ally wrought  in  the  matter  of  physical  restraint  was 
perhaps  on  the  whole  very  small  as  compared  with 
the  amount  of  agitation  which  the  subject  received. 
Institutions,  during  the  past  generation  at  least, 
went  on  and  continued  to  go  on  much  as  they  had 
before,  while  here  and  there  came  forth  a  man  like 
Page,  already  mentioned,  who  stood  out  for  absolute 
non-restraint  and  who  succeeded  in  effecting  his 
ends  by  giving  an  enormous  amount  of  personal  at- 
tention and  never  ending  vigilance  to  that  particular 
problem.  Other  institutions  went  their  way  with- 
out very  much  change,  unless  they  were  brought  to 
book  by  serious  criticism,  and  still  others,  and  this 
applies  perhaps  to  the  larger  number,  substituted 
chemical  restraint  for  physical  restraint,  a  substitu- 
tion of  very  doubtful  advantage.  Patients,  from  be- 
ing manacled,  tied,  placed  in  camisoles,  or  under 
strong  sheets,  were  made  continuously  stupid  by 
the  administration  of  powerful  drugs.  This  largely 
was  yielding  to  the  letter  of  the  new  ideal,  but  not 
to  its  spirit.  The  humanitarian  movement,  the  ef- 
forts towards  kindliness  and  consideration  in  the 
treatment  of  these  unfortunate  people  seemed  still 
to  be  effectually  stopped  by  the  same  factors  that 
wrought  such  havoc  hundreds  of  years  before, — 
ignorance  and  fear.  Progress  beyond  a  certain 
point  seemed  practically  impossible,  except  as  here 
and  there  it  was  the  reflection  of  some  great  person- 
ality.   To  illustrate  the  state  of  affairs  I  will  quote 


THE  INSANE  73 

from  the  preface  of  an  anonymous  publication  of 
1823.  It  is  called  ''Sketches  in  Bedlam,"  and  con- 
tains a  short  account  of  that  historic  institution,  to- 
gether with  the  case  histories  of  a  considerable  num- 
ber of  its  inmates.  ''Among  the  great  charitable 
establishments  of  the  British  empire  this  holds  a 
pre-eminent  rank,  and  by  the  excellence  of  its  regu- 
lations and  medical  treatment,  it  may  be  justly  con- 
sidered a  model  of  imitation  for  all  Europe.  For 
this  rare  improvement  Bethlehem  Hospital  is  in- 
debted to  a  series  of  measures,  planned  and  executed 
with  consummate  wisdom  and  indefatigable  per- 
severance. Experience  was  the  grand  basis  of  these 
measures.  During  a  long,  minute,  and  patient  in- 
vestigation, carried  on  through  successive  sessions, 
by  a  Parliamentary  Committee,  the  practice  adopted 
in  all  other  establishments  of  a  similar  nature, 
whether  public  or  private,  throughout  the  United 
Kingdom,  was  diligently  examined;  the  skill  and 
opinions  of  all  the  medical  men  most  conversant 
with  the  subject,  were  attentively  consulted  and 
compared.  The  detection  and  reform  of  errors  and 
abuses,  arising  from  ignorance,  apathy,  caprice, 
or  cruelty,  which  had  been  too  long  prevalent,  con- 
stituted the  happy  result  of  that  laborious,  but 
humane  inquiry;  and  benevolence  was  never,  per- 
haps, consecrated  by  a  nobler  triumph,  than  when 
it  was  satisfactorily  demonstrated,  that  force  and 
terror,  instead  of  alleviating,  tended  but  to  aggra- 
vate the  miseries  and  horrors  of  insanity  and  de- 
lirium.   The   philanthropic  views    of   the   British 


74  MENTAL  HYGIENE 

legislature  and  the  British  nation  were  at  length 
realized.  Harsh  usage  and  irritating  coercion  gave 
way  to  mildness,  forbearance,  and  indulgence,  and 
the  wretched  inmates  of  this  asylum  of  mental  de- 
rangement were  liberated  from  unnecessary  vio- 
lence, intimidation,  and  soKtary  confinement." 
Surely  this  might  have  been  written  yesterday. 
The  objects,  the  aims,  are  our  own  objects  and  aims, 
the  intentions  are  as  good  as  they  could  be.  "When 
we  turn  from  this  preface  to  the  account  of  the 
cases  we  find  that  the  first  case,  Patrick  Walsh,  is 
described  in  considerable  detail.  Let  me  quote  you 
from  the  description  of  his  case.  After  having 
killed  a  fellow  patient  the  following  is  a  description 
of  the  means  that  were  taken  to  restrain  him  by  the 
keeper.  * '  He  had  put  on  him  at  first  a  pair  of  hand- 
cuffs of  extraordinary  strength,  made  purposely  for 
himself,  which  he  broke  in  a  very  short  time.  The 
keeper  then  put  on  him,  by  order,  two  pairs  of  the 
common  handcuffs;  but  these,  within  two  hours 
afterwards,  he  smashed  into  a  hundred  pieces.  It 
was  then  found  necessary  to  contrive  other  mfeans 
for  his  restriction,  consisting  of  an  iron  cincture 
that  surrounds  his  waist,  with  strong  handcuffs  at- 
tached to  it,  sufficient  to  check  his  powers  of  manual 
mischief,  but  with  liberty  for  all  his  requisite  occa- 
sions of  food,  drink,  taking  snuff,  etc.,  etc.  Such 
are  the  means  for  his  restraint  day  by  day:  not 
painful  to  him,  but  merely  for  the  safety  of  others. 
At  night  it  is  found  necessary  to  fasten  him  by  one 
hand  and  leg  to  his  bedstead,  with  strong  locks  and 


THE  INSANE  75 

chains.  ...  He  is  locked  up  in  his  own  room,  the 
door  of  which,  as  well  as  that  of  the  dining  room,  are 
made  of  remarkable  strength,  with  double  bolts,  and 
perfectly  secure;  for  he  would  break  through  the 
common  bed-room  doors  instantly."  You  will  see 
that  with  all  the  ideals  just  as  they  should  be  the 
result  is  the  same  old  result.     Why  is  this  1 

With  the  ideal  of  kindness  we  had  been  expecting 
to  accomplish  everything,  we  had  left  out  a  con- 
sideration of  the  personal  equation,  the  personal 
equation  in  this  instance  being  a  function  usually  of 
ignorance  and  fear.  Kindliness  alone  could  never 
solve  the  problem.  There  might  be  individuals  with 
a  sufficiently  inexhaustible  fund  of  tenderness  to- 
wards the  unfortunate  who  would  never  lose  their 
temper,  who  would  never  be  irritated  by  what  they 
did,  but  this  certainly  could  apply  only  to  a  small 
number  of  individuals.  How  about  the  nurses,  or 
more  usually  attendants,  who  have  to  spend  the  en- 
tire day  on  the  wards  with  troublesome,  irritating, 
violent,  abusive,  dirty,  destructive  patients?  Can 
kindliness  go  on  day  after  day  in  the  face  of  the 
most  absolutely  irritating  of  all  possible  things,  pa- 
tients persistently  filthy,  destructive,  noisy,  profane 
and  abusive,  apparently  for  no  other  reason  than 
to  irritate  their  caretakers?  How  can  a  simple 
country  girl,  who  is  called  in  from  the  surround- 
ing district  to  this  work,  be  expected  to  preserve 
a  uniformly  kindly  attitude  towards  this  sort 
of  situation  when  there  is  absolutely  no  light  in  it 
for  her,  nothing  which  points  to  any  explanation 


76  MENTAL  HYGIENE 

other  than  the  explanation  which  occurs  to  her  of 
innate  cussedness,  and  yet  the  girls  and  boys  that 
were  brought  in  from  the  surrounding  districts  to 
take  care  of  these  patients  did  measure  up,  in  a  way 
that  is  nothing  short  of  remarkable,  to  the  demands 
that  the  institutions  made  upon  them.  I  do  not 
know  of  any  greater  tribute  that  could  be  paid  to 
the  innate  decency  of  human  nature  than  the  tribute 
that  is  paid  every  day  by  the  young  men  and  the 
young  women  on  the  wards  of  institutions  caring 
for  this  class  of  patients  who  have  nothing  within 
them  to  draw  upon  but  just  their  spirit  of  kindli- 
ness, gentleness,  and  sympathy,  without  in  the  ma- 
jority of  cases  one  beam  of  a  real  intelligent  appre- 
ciation of  what  it  all  means.  It  became  apparent 
that  something  more  than  kindness  was  needed  and 
that  something  more  was  knowledge. 

THE   IDEAL   OF   KNOWLEDGE 

It  has  been  shown  in  the  previous  chapter  how 
people  are  continually  trying  to  escape  from  the 
demands  of  reality.  This  is  the  key  to  the  under- 
standing of  the  psychosis.  In  the  psychosis  there  is 
a  very  successful  *' flight  from  reality,"  so  successful 
in  fact  as  to  quite  incapacitate  the  patient  for  life  ex- 
cept in  a  well  protected  situation,  usually  an  institu- 
tion. The  psychotic,  however,  does  something  more 
than  run  away  from  reality.  In  place  of  the  world 
he  can  not  live  in  he  builds  a  new  world  in  which  he 
can  live.  It  is  our  business  to  try  and  find  out  about 
this  world  of  his  as  a  necessary  precondition  to  any 


THE  INSANE  77 

intelligent  effort  to  help  him  back  into  the  world 
shared  in  conunon  by  his  fellows.  To  do  this  we 
must  learn  to  understand  his  language,  be  able  to 
know  what  his  delusions  mean.  This  is  the  ideal  of 
knowledge,  the  interpretative  phase  in  our  study 
of  the  psychoses  which  must  replace  the  simple  de- 
scriptive phase  which  was  satisfied  with  recording 
a  symptom  and  thought  no  more  about  it.  We  must 
learn  to  read  meaning  into  the  symptoms  of  mental 
disease  just  as  physicians  in  other  departments  of 
medicine  have  learned  to  read  meaning  into  the 
symptoms  of  the  diseases  they  treat.  To  inquire 
into  the  meaning  of  a  delusion  is  on  all  fours  with 
enquiring  into  the  meaning  of  an  eruption  and  a  rise 
in  temperature. 

Not  only  is  this  true  from  the  scientific  point  of 
view  but  it  is  equally  true  from  the  patient's  point 
of  view.  Any  one  who  has  been  ill  knows  how  im- 
portant it  is  for  his  peace  of  mind  to  feel  that  the 
physician  understands  his  symptoms,  it  is  the  basis 
of  confidence.  It  is  equally  true  of  mental  symp- 
toms, and  without  doubt  a  great  amount  of  the  fric- 
tion between  patient  and  institution  is  based  solely 
upon  this  ignorance.  An  individual-society  dis- 
harmony has  only  too  frequently,  in  the  past,  been 
replaced  by  a  patient-institution  one  when  the  men- 
tally ill  person  was  committed. 

An  attitude  on  the  part  of  the  institution  that  sees 
in  a  restless  irritability  simply  something  to  be  re- 
pressed is  not  only  unintelligent  but  invites  a  con- 
tinuation of  the  very  condition  it  is  trying  to  do 


78  MENTAL  HYGIENE 

away  with  and  helps  by  the  very  repressive  meas- 
ures used  to  effect  this  end  and  to  create  and  con- 
tinue that  patient-institution  disharmony  upon  which 
it  is  very  frequently  based. 

To  give  an  example :  A  patient  kicks  out  a  lot  of 
window-lights  in  a  paroxysm  of  uncontrolled  irri- 
tation, perhaps  cuts  himself  in  so  doing,  gets  into  a 
general  squabble  with  his  care-takers  who  endeav- 
our to  restrain  him,  maybe  with  the  result  that  the 
physician  in  charge  of  that  department  is  tele- 
phoned for.  Now  if  knowledge  is  not  the  ideal  of 
the  institution  how  shall  such  a  situation  be  dealt 
with?  The  patient  has  been  irritated,  has  been  dis- 
turbed, has  yielded  to  his  irritation,  has  gotten  into 
a  mix-up,  a  general  disturbance  on  the  ward  has 
resulted,  a  lot  of  window-lights  have  been  kicked 
out,  one  or  two  people  have  been  struck,  and  tem- 
porarily the  whole  ward  has  been  thrown  into  con- 
fusion. What  can  be  the  object  in  dealing  with  this 
situation?  Simply  that  the  patient  must  be  so  cared 
for  that  he  cannot  go  on  breaking  out  window-lights, 
that  he  cannot  go  on  getting  into  squabbles  with 
other  people,  that  he  cannot  go  on  striking,  kicking, 
tearing.  How  is  such  a  thing  to  be  accomplished? 
There  are  not  very  many  ways.  The  natural  way  in 
recent  years  would  be  to  give  him  a  hypodermic  or 
some  powerful  drug  which  would  put  him  to  sleep. 
A  little  longer  ago  he  would  have  been  put  in  a  cami- 
sole, and  in  any  case  he  is  shut  up  in  a  room  by  him- 
self, perhaps  fastened  to  a  bed,  the  ward  is  re- 
adjusted, the  lights  are  put  back  in,  the  patient  con- 


THE  INSANE  79 

tinues  in  more  or  less  restraint  for  an  indefinite 
period  of  time,  from  which  he  may  gradually  emerge 
to  repeat  the  same  kind  of  procedure  with  the  same 
kind  of  results.  No  matter  how  much  kindliness 
may  animate  everybody  concerned,  it  will  be  agreed 
that  nothing  especial  has  been  accomplished,  except 
that  the  patient  has  been  successfully  repressed, 
usually  very  much  to  his  discomfort,  sometimes  to 
his  actual  terror.  Now  if  the  ideal  of  knowledge  is 
the  ideal  which  animates  this  institution,  what  will 
happen?  The  doctor  will  come  to  the  ward,  he  will 
dress  the  wounds  of  the  patient,  if  there  are  wounds 
to  dress,  and  then  what  will  he  do?  The  natural 
thing  for  him  to  do,  if  such  an  occurrence  as  this  is 
perchance  the  first  in  the  history  of  this  patient,  is 
to  try  to  find  out  what  it  means,  why  did  the  patient 
smash  out  these  window-lights,  was  he  disturbed,  ir- 
ritated by  somebody  else  about  him,  and  if  so  could 
a  little  different  distribution  of  patients  be  made  to 
their  mutual  advantage,  or  did  the  cause  lie  within 
himself?  Was  smashing  out  the  window-lights  a 
certain  expression  of  something  that  was  going  on 
within?  Certainly  there  must  be  some  reason  why 
the  patient  broke  out  the  window  lights  and  did  not 
break  furniture,  why  he  did  it  at  that  particular 
time,  and  why,  as  he  probably  did,  he  got  relief  from 
so  doing.  The  whole  attitude  of  the  physician  to- 
wards the  problem  would  be  to  endeavour,  as  far  as 
possible,  to  try  and  find  out  the  answers  to  all  these 
questions,  and  he  will  try  and  find  out  not  only  from 
the  patients,  but  the  nurses ;  he  will  question  every- 


80  MENTAL  HYGIENE 

body  for  light  on  the  situation  so  that  it  may  be  dealt 
with  more  intelligently,  so  that  perhaps  the  knowl- 
edge gained  may  be  used  to  the  advantage  of  the  pa- 
tient and  help  in  a  little  way  perchance  towards  his 
recovery.  Can  not  you  see  how  such  an  attitude  to- 
wards such  a  situation  sinks  all  questions  of  per- 
sonal irritation?  There  no  longer  is  any  problem 
of  whether  the  patient  is  to  be  roughly  handled, 
strapped  up  in  some  restraining  apparatus,  terri- 
fied, hurt.  Nothing  personal  can  enter  into  this  ex- 
cept the  love  which  the  doctor  has  for  his  work  and 
which  is  reflected  in  this  individual  situation.  Doc- 
tors, nurses,  patients,  every  one,  see  an  absolutely 
new  attitude  toward  this  kind  of  occurrence,  an  at- 
titude of  trying  to  understand,  trying  to  find  the 
meaning  in  the  peculiar,  aberrant,  distorted  ways  in 
which  only  the  patient  is  able  to  express  himself, 
for  remember  the  patient  speaks  a  language  that 
we  must  learn.  We  can  not  expect  him  to  speak  our 
language,  we  must  learn  his,  and  this  attitude  of  try- 
ing to  understand  is  one  of  helpfulness,  construc- 
tive helpfulness,  never  one  of  kindliness  alone,  which 
may  easily  degenerate  into  sentimentality.^  It  is 
constructive  and  helpful,  it  does  away  with  the  ne- 
cessity for  meeting  other  problems,  for  the  minute 
such  an  ideal  dominates,  these  problems  cease  to 
exist. 
In  an  institution  dominated  by  the  ideal  of  scien- 

3  Of  course  I  do  not  mean  to  be  understood  as  implying  that  kind- 
ness is  no  longer  an  ideal.  It  is,  but  the  ideal  of  kindness  is  the 
kindness  that  is  grounded  in  knowledge. 


THE  INSANE  81 

tific  knowledge,  this  ideal  will  so  permeate  the  at- 
mosphere and  its  effects  will  be  so  profound  upon 
the  staif,  upon  the  employes,  upon  all  in  fact,  that 
there  will  gradually  grow  out  of  such  a  new  stand- 
point a  hospital  finally  and  everlastingly  free  from 
the  shackles  of  ignorance  and  fear,  a  hospital  in 
which  the  patient  will  be  received  with  the  same  un- 
derstanding attitude  that  the  patient  with  physical 
disease  is  now  received  in  a  general  hospital,  and 
when  the  patients  are  so  received,  and  when  they 
are  so  dealt  with,  the  number  of  instances  of  violent 
outbreaks,  serious  injury,  of  resorting  to  terrorizing 
and  repressing  measures,  will  sink  to  an  inconsider- 
able minimum. 

If  there  is  going  to  be  antagonism  between  the 
institution  and  the  patient  it  will  begin  the  moment 
the  patient  is  received.  If  the  ideal  of  scientific 
knowledge  dominates  the  hospital  the  patient  will 
be  received  into  an  atmosphere  that  he  feels  at  once 
to  be  filled  with  interest,  desire  to  understand,  con- 
structive helpfulness,  and  from  the  very  first  there 
will  be  no  occasion  for  that  revulsion  in  his  feelings 
which  so  sensitize  him  to  irritation,  and  so  lay  the 
foundation  for  future  outbreaks  of  irritability,  re- 
sentment, resistance  to  the  institution  environment 
and  influences. 

The  introduction  of  the  ideal  of  scientific  knowl- 
edge places  the  whole  institution  upon  a  higher 
plane,  not  only  in  the  community,  but  in  the  minds 
of  the  very  people  who  make  up  its  personnel.  The 
physician  is  dignified  by  being  no  longer  a  boarding 


82  MENTAL  HYGIENE 

house  keeper,  but  a  professional  man,  practicing  his 
profession  with  a  full  equipment  of  the  necessary 
tools.  He  will  be  placed  in  a  dignified  position 
which  will  command  the  respect  of  his  professional 
brethren.  The  hospital  will  assume  its  proper  place 
in  the  community  as  the  source  of  all  the  best  in- 
formation about  mental  diseases  and  mental  medi- 
cine ;  the  physicians  will  take  their  natural  places  as 
possessors  and  exploiters  of  that  knowledge;  the 
nurse  will  feel  that  she  is  truly  practicing  a  definite 
nursing  specialty,  based  upon  scientific  experience 
and  not  upon  a  lot  of  sentimental  platitudes;  and 
the  community  will  feel  that  they  have  in  their  midst 
a  truly  representative  institution  which  stands  in  a 
position  to  extend  aid  to  them  when  they  need  it, — 
aid  of  the  most  approved,  recent,  and  valuable  kind. 
The  French  failed  to  build  the  Panama  Canal,  not 
because  of  any  inherent  defects  in  the  French  as  a 
people,  but  because  the  task  at  that  time  was  not 
humanly  possible.  The  hospitals,  for  example, 
which  they  built  upon  the  Isthmus  were  provided, 
among  other  things,  with  large  quantities  of  tropical 
plants,  which  of  course  had  to  be  kept  properly  wa- 
tered in  order  that  they  might  grow.  These  plants, 
with  their  little  puddles  of  water  standing  about 
them,  were  the  very  best  breeding  places  in  the 
world  for  the  mosquito.  It  was  not  known  then 
that  the  mosquito  carried  malaria,  and  so  in  their 
efforts  to  take  care  of  the  sick  they  did  the  one  thing 
above  all  others  that  defeated  anything  else  that 
they  might  do,  they  provided  the  very  means  for  the 


THE  INSANE  83 

spreading  of  the  disease  which  was  destroying  them, 
because  they  did  not  know.  The  discovery  of  the 
mosquito  as  the  transmitting  agent  of  malaria  is 
one  of  the  discoveries  which  was  necessary  be- 
fore the  Panama  Canal  could  be  dug,  and  so  all  the 
steps  that  I  have  described  as  preceding  the  intro- 
duction of  scientific  work  into  the  hospital  for  the 
care  and  treatment  of  the  mentally  diseased,  all  of 
these  steps  were  necessary  and  had  to  precede  the 
present  one,  which  is  symbolized  by  the  ideal  of 
knowledge. 

Some  of  the  States  are  beginning  to  appreciate 
not  only  their  duties  to  those  who  have  been  crippled 
by  disease,  but  are  also  appreciating  the  opportuni- 
ties which  the  accumulation  of  large  numbers  of 
the  mentally  diseased  afford  for  scientific  study. 
To  go  on  year  after  year  housing  and  caring  for 
those  who  are  unable  to  care  for  themselves  without 
ever  asking  Why?  to  bear  the  steadily  increasing 
burden  of  illness  and  inefficiency  without  ever  ask- 
ing To  what  end?  to  be  confronted  with  a  problem 
and  never  attempt  its  solution,  all  this  is  unintelli- 
gent. There  is  a  problem,  there  is  a  burden.  Only 
by  that  painstaking  and  analytic  scrutiny  we  call 
scientific  can  the  elements  involved  in  the  problem 
become  known,  and  only  when  they  have  become 
known  does  it  become  possible  to  intelligently  at- 
tempt their  solution.  The  care  and  treatment  of 
the  so-called  insane  has  passed  through  the  period 
of  superstition  into  the  period  of  philanthropy.  It 
is  now  passing  through  the  period  of  philanthropy 


84  MENTAL  HYGIENE 

to  a  still  higher  stage, — the  period  of  knowledge. 
Knowledge,  and  knowledge  alone  will  provide  the 
data,  make  possible  the  solution  of  the  many  prob- 
lems involved  and  finally  and  most  important  of  all, 
it  will  be  the  means  of  developing  principles  which 
will  effectively  bring  this  branch  of  medicine  within 
the  field  of  endeavour  of  preventive  medicine.  The 
great  hospitals  for  the  insane  must  become  the 
laboratories  where  these  immensely  important  so- 
cial problems  are  worked  out.  The  knowledge 
which  is  primarily  needed  is  the  knowledge  of  the 
nature  of  the  psychic  disharmonies  which  are  at  the 
basis  of  mental  disease  and  to  which,  in  specific 
instances  we  give  the  name  of  conflict. 

THE   CONFLICT 

The  antithesis  of  instinct,  which  seeks  the  fa- 
miliar, and  the  reality  motive  which  urges  the  in- 
dividual forward  and  into  the  region  of  the  un- 
known, has  already  been  indicated  in  the  previous 
chapter.  Every  psychosis — mental  disease — can  be 
understood  as  such  a  conflict.  This,  however,  is  not 
saying  enough.  Every  psychological  integration, 
and  for  that  matter  integration  at  all  other  levels 
results  from  just  such  conflicts.  The  conflict  states 
the  problem,  the  significant  thing  is  the  way  in 
which  it  is  answered.  It  may  be  pictured  as  two  op- 
posing forces  meeting  on  a  certain  plane.  The  re- 
sult may  be  the  yielding  of  one  and  the  ascendancy 
of  the  other;  a  repeated  vacillation,  first  one  and 
then  the  other  gaining  the  ascendancy;  disaster,  by 


THE  INSANE  85 

the  smashing  of  one  by  the  other ;  or  finally  a  higher 
integration  in  a  new  setting.  For  example:  The 
conflict  is  between  the  flexor  muscles  and  the  exten- 
sor muscles  of  the  leg.  One  may  overcome  the  other 
— the  leg  is  either  flexed  or  extended;  neither  one 
is  able  to  dominate — the  leg  alternates  between  par- 
tial flexion  and  partial  extension;  one  force  breaks 
through  the  resistance  of  the  other — ^the  bone  is 
broken  (fracture  of  the  knee  cap — a  not  unusual  re- 
sult of  sudden  extension  when  time  is  not  given,  in  a 
sudden  effort  at  extension,  for  the  flexors  to  relax) ; 
or  a  well  adjusted  movement  for  the  accomplish- 
ment of  a  given  end  by  the  orderly  and  integrated 
action  of  both  sets  in  harmony,  i.e.,  while  one  set 
of  muscles  is  being  flexed  the  opposing  group  is 
correspondingly  extending. 

This  illustration  may  be  taken  over  to  the  psy- 
chological level.  A  wish  is  carried  into  execution 
— there  is  a  simple  overcoming  of  opposition  (the 
individual  overcomes  his  inertia  in  face  of  a  task) ; 
neither  tendency  is  able  to  overcome  the  other — a 
state  of  doubt  results  in  which  first  one  and  then 
the  other  course  of  conduct  is  decided  upon;  one 
smashes  the  other — instinct  succeeds  in  shutting 
out  reality — a  psychosis  results ;  or  a  higher  integra- 
tion is  reached  by  combining  both  motives  in  a  subli- 
mated, socialized  form  of  conduct. 

A  psychosis  results  when  reality  is  overcome. 
The  patient  becomes  asocial  and  then  can  only  carry 
out  his  wishes  by  a  form  of  conduct  which  is  recog- 
nized as  evidence  of  sickness.    A  boy,  for  example, 


86  MENTAL  HYGIENE 

the  case  already  cited  (Chapter  III),  wishes  to  over- 
come his  father,  and  develops  a  peculiar  feeling  in 
his  arm,  thus  reproducing  a  psychological  situation 
in  which  he  had  previously  succeeded  in  doing  so. 
A  patient  who  once,  because  of  a  neuralgia  of  tjie 
arm  muscles  could  not  work,  later  develops  pain  in 
the  arm  muscles,  of  psychological  origin  (psycho- 
genic) in  fear  of  a  new  situation  when  confronted 
by  a  task  she  does  not  wish  to  perform.  The  en- 
ergy in  these  cases  is  not  available  for  adequate  ad- 
justment, the  conduct  is  inadequate  to  the  situa- 
tion. 

In  sublimated,  or  socialized  integration  the  two 
forces  are  gathered  up  in  a  higher  synthesis.  The 
desire  for  wealth  is  socialized  along  those  accepted 
lines  of  activity  which  are  recognized  as  being  legit- 
imate ways  of  obtaining  it. 

Now  from  this  point  of  view,  it  will  be  seen 
that  a  conflict  can  only  meet  a  socialized  solution 
either  by  repression — the  overcoming  of  instinct  by 
the  reality-motive — or  better  yet  by  a  higher  form 
of  integration  in  which  both  motives  are  made  to 
subserve  a  higher  end.  A  simple  story  will  illus- 
trate this  apropos,  at  this  point,  of  the  illustration 
of  the  example  of  the  unruly  patient  who  became  ex- 
cited and  broke  out  some  window  panes.  Once  upon 
a  time,  so  the  story  goes,  there  were  a  number  of 
students  collected  in  a  laboratory;  they  were  dis- 
cussing various  problems  among  themselves;  they 
had  just  entered  a  room  together,  and  as  they  en- 


THE  INSANE  87 

tered  they  noticed,  sitting  on  a  table  by  the  window, 
a  bowl.  This  bowl  happened  to  be  so  placed  that 
the  sunlight  that  streamed  in  through  the  window 
covered  approximately  that  one  half  of  the  bowl 
which  was  towards  the  window.  One  of  the  stu- 
dents, in  casually  placing  his  hand  upon  the  bowl  as 
he  went  by,  noticed,  to  his  amazement,  that  the 
portion  of  the  bowl  that  was  in  the  sunlight  was 
cooler  than  the  portion  that  was  in  the  shade.  He 
called  the  attention  of  his  companions  to  this  phe- 
nomenon. They  all  verified  it  for  themselves  and 
then  there  arose  a  stormy  argument  as  to  the  rea- 
son for  this  peculiar  manifestation.  All  sorts  of 
reasons  were  advanced,  the  argument  became  more 
and  more  animated,  voices  were  raised  to  higher 
pitch ;  it  was  a  veritable  wrangle,  each  man  wishing 
to  have  his  say  without  regard  to  the  others,  and 
interrupting  them  without  consideration.  This 
scene  had  been  going  on  for  some  moments  when 
the  attention  of  the  janitor  was  attracted.  He 
listened,  however,  for  a  while  and  then  finally  seiz- 
ing the  opportunity  offered  by  a  momentary  lull, 
he  volunteered  to  explain  what  had  happened.  The 
students  incredulously  turned  toward  him,  but  per- 
mitted him  to  go  on.  His  explanation  was  simple ; 
he  said  that  just  before  they  came  into  the  room 
he  had  turned  the  bowl  about.  With  the  pronounce- 
ment of  these  few  simple  words  the  whole  storm 
subsided,  there  no  longer  was  any  need  for  hy- 
potheses, there  was  no  longer  any  problem  to  be 


88  MENTAL  HYGIENE 

solved.  Knowledge  had  dissipated  the  necessity  of 
a  solution,  because  in  the  light  of  that  knowledge 
there  was  no  problem. 

This  story  tells  in  a  simple  way  the  story  of  the 
resolution  of  the  conflict.  It  shows  how  the  intro- 
duction of  a  new  element,  knowledge,  could  gather 
up  all  the  conflicting  points  in  the  evidence  and 
bring  them  to  a  satisfying  synthesis,  and  how  as 
soon  as  this  was  done,  there  was  nothing  further  to 
discuss — the  conflict  was  at  an  end.  It  is  an  illus- 
tration of  the  ideal  of  knowledge. 

Now,  the  patient  in  a  hospital  who  is  unruly,  as 
this  one  was,  and  who  acts  instinctively,  if  met  by 
just  repression  on  the  part  of  the  hospital  authori- 
ties, is  not  helped  in  any  way.  The  various  acts  of 
repression,  restraint  (physical  or  chemical)  are 
themselves  instinctive  acts  and  at  the  same  level  as 
those  of  the  patient.  The  patient  may  be  overcome 
but  nothing  has  been  accomplished  that  is  construc- 
tive. To  succeed  there  must  he,  to  use  a  legal 
phrase,  a  '' meeting  of  minds"  and  not  just  a  clash- 
ing of  instincts.  Such  a  disturbance  as  described, 
due  to  a  clashing  of  instincts,  is  an  artificial  creation 
of  an  environment  incapable  of  adequately  dealing 
with  the  situation.  In  an  institution  dominated  by 
an  effort  to  understand  and  help  (love)  such  a  situa- 
tion would  not  arise,  or  at  least  not  as  frequently, 
and  when  it  did  would  be  met  in  a  constructive  way. 
By  this  I  mean  it  would  tend  to  be  met  in  that  way 
in  which  every  difficult  situation  in  life  should  be 
met — by  trying  to  learn  that  from  it  which  would 


THE  INSANE  89 

be  helpful  in  avoiding  such  things  in  the  future. 
If  patients  are  dealt  with  in  this  way  then  such  an 
outbreak  may  be  of  the  greatest  value  in  bringing 
them  to  such  an  understanding  of  themselves  as  will 
be  helpful  in  bringing  about  that  readjustment 
which  spells  recovery. 

THE   HOSPITAL 

In  the  past  few  years  a  great  change  has  come 
over  many  hospitals  for  the  insane.  The  improve- 
ment in  conditions  is  evident  to  the  most  casual  ob- 
server. There  does  not  begin  to  be  such  a  large 
class  of  noisy,  filthy  and  destructive  patients,  and 
throughout  the  institution  there  are  all  sorts  of  evi- 
dences of  improvement,  not  only  in  the  physical 
surroundings  but  in  the  state  of  mind  of  the  pa- 
tients. They  are  more  at  home,  more  composed, 
calmer  and  happier — in  short  they  are  better  ad- 
justed to  a  better  environment.  If  the  superin 
tendent  of  such  a  hospital  were  asked  to  what  the 
improvement  was  due  he  would  probably  have  a 
good  deal  of  difficulty  in  finding  an  answer,  in  put- 
ting his  finger  upon  any  specific  explanation.  This 
would  particularly  be  so  if  he  had  only  been  in  the 
work  a  short  time,  if  he  had  not  lived  through  the 
transition  period  and  seen  the  changes  slowly 
brought  about.  The  truth  of  the  matter  is,  there  is 
no  specific  reason  for  this  great  change.  It  has 
been  brought  about  by  a  multitude  of  causes,  among 
which  important  ones  are  the  taking  over  by  the 
State  of  the  care  of  the  insane  (State  care)  which 


90  MENTAL  HYGIENE 

has  meant  the  abolition  of  the  County  system,  the 
county  having  been  proven  to  be  too  small  a  pohtical 
unit  to  grapple  with  such  a  large  problem:  the  re- 
moval of  the  hospital  from  politics  and  so  saving 
it  from  the  evils  of  a  political  spoils  system:  plac- 
ing the  control  of  the  hospital  absolutely  in  the 
hands  of  a  physician  and  so  recognizing  the  over- 
whelmingly medical  character  of  the  problems :  the 
maintenance  of  training  schools  for  nurses  in  the 
hospital  and  so  raising  the  standard  of  care  and  of 
the  care  takers:  placing  physicians  under  Civil 
Service  regulations  and  basing  promotion  on  merit, 
thus  attracting  a  better  class  of  medical  men  to  the 
work ;  the  introduction  of  courses  in  mental  medicine 
in  the  various  medical  colleges,  and  so  better  equip- 
ping physicians  for  specializing  in  this  field :  *  rec- 
ognition of  the  evils  of  over-crowding  and  a  cor- 
responding attempt  to  correct  them:  the  incorpora- 
tion of  industries  and  the  consequent  employment 
of  a  larger  number  of  patients.  All  of  these  have 
been  factors  in  the  net  result  and,  in  fact,  many 
more  changes  have  contributed  to  that  end  but 
these  are  perhaps  the  most  important.  Summing 
them  all  up  they  are  moves  in  the  direction  of  a 
greater  knowledge  of  the  problem,  of  the  deeper  un- 
derstanding of  the  insane  and  of  the  nature  and 
meaning  of  mental  disease. 
What  has  been  accomplished  by  the  hospitals 

4  Strange  as  it  may  seem  it  is  only  within  comparatively  recent 
years  that  any  attempt  has  been  made  to  systematically  teach 
psychiatry  in  the  medical  schools. 


THE  INSANE  91 

simply  by  substituting  kindness  for  the  cruelty  of 
ignorance  and  the  neglect  and  consequent  brutality 
which  was  the  outcome  of  fear  I  can  illustrate  no 
better  than  by  a  quotation  from  the  Report  of  the 
State  Board  of  Public  Charities  of  Illinois  for  1906. 

*'A  famous  patient,  who  died  recently,  was  Ehoda 
Derry.  This  woman  had  been  discovered  by  an  in- 
spector of  a  previous  board  of  charities,  locked  in 
a  room  of  the  Adams  County  almshouse.  For  forty 
years  she  had  been  kept  in  a  rough  box  bed,  with 
about  such  toilet  facilities  as  are  provided  for  ani- 
mals in  captivity.  She  had  scratched  out  her  eyes. 
She  was  taken  to  Bartonville  and  carried  in  a  basket 
up  the  hill  to  the  asylum.  She  was  placed  in  a 
white  enamel  bed  in  a  room  flooded  with  sunshine. 
She  had  expert  medical  and  nursing  service.  She 
became  a  pet  of  the  great  institution.  When  she 
died  the  nurses  cried.  Such  is  the  contrast  of  State 
with  county  care  of  the  insane. ' '  ^ 

The  State  Hospital  has,  at  its  best  at  least,  long^ 
passed  from  the  stage  of  dense  ignorance  with  stud- 
ied neglect  instead  of  care  as  its  offering  to  its  unfor- 
tunate inmates.  From  this  state  of  affairs  it  has 
passed  by  way  of  the  philanthropic  stage  of  develop- 
ment to  standards  of  ''no-restraint,"  kindness,  com- 
fortable housing  and  medical  attendance.  From 
this  point  in  development  the  best  hospitals  are 

5  For  an  account  of  an  actual,  present  existing  state  of  aflfairs 
such  as  that  which  produced  the  results  described  in  the  case  of 
Rhoda  Derry  read  the  article  by  Dr.  T.  W.  Salmon,  "The  Insane  in  a 
County  Poor  Farm,"  in  Mental  Hygiene,  January,  1917. 


92  MENTAL  HYGIENE 

forging  ahead  on  the  path  of  scientific  progress — 
the  ideal  of  knowledge. 

THE   AGEN-CIES 

The  State  Hospitals — The  agencies  which  are 
available  for  attacking  the  problem  of  mental  dis- 
ease in  the  community  are  first  of  all  the  large  State 
Hospitals  which  are  the  natural  centers  in  their  sev- 
eral communities  from  which  all  good  influences 
should  have  their  origin.  Something  of  the  history 
of  the  development  of  these  institutions  and  their 
present  tendencies  I  have  already  indicated.  Aside 
from  taking  care  of  and  treating  the  cases  sent  to 
them  they  should  be  the  natural  places  to  turn  to 
for  all  information  of  any  sort  on  the  subject  of 
mental  disease,  and  for  assistance  in  all  of  the  prob- 
lems of  the  community  into  which  this  problem  en- 
ters. They  should  be  as  much  the  centers  of  in- 
formation and  assistance  along  these  lines  as  the 
old  Gothic  Cathedrals  of  Europe  were  the  centers 
of  the  religious,  business  and  social  life  of -the  dis- 
tricts in  which  they  were  located. 

The  Psychopathic  Hospital, — The  psychopathic  hos- 
pital is  the  receiving  hospital  for  mental  cases  in 
the  larger  cities.  Here  all  mental  cases  are  re- 
ceived and  reclassified,  some  going  to  the  State  Hos- 
pital, some  going  home,  some  remaining  a  short  time 
for  treatment,  etc.  It  is  the  clearing  house  for  men- 
tal disease  in  the  community. 

Dispensary   Service — Out-patient   service   is   begin- 


THE  INSANE  93 

ning  to  be  established  in  connection  with  dispen- 
saries as  mental  disease  is  coming  to  be  dealt  with 
by  the  medical  profession  outside  of  the  asylum 
walls — extra-mural  psychiatry.  The  out-patient 
service  typically  originates  in  the  State  Hospital 
and  the  Psychopathic  Hospital  and  later  branches 
out  from  neurological  clinics  in  general  dispensaries. 

Social  Service — In  connection  with  State  Hospi- 
tals, Psychopathic  hospitals  and  dispensaries,  field 
workers  put  the  medical  officer  in  touch  with  outside 
living  conditions  and  co-operate  in  helping  the  hos- 
pital to  discharge  patients  more  intelligently,  and 
also  in  helping  to  readjust  living  conditions  es- 
pecially along  the  lines  that  had  responsibility  for 
the  mental  break. 

After-care — A  further  kind  of  social  service  cal- 
culated to  assist  the  discharged  patient  to  rehabili- 
tate himself  in  the  community. 

Other  Social  Agencies — Various  social  and  char- 
itable organizations  both  public  and  private  are 
constantly  running  across  the  problem  of  mental 
disease.  All  sorts  of  distress,  poverty  and  crime 
are  complicated  or  more  or  less  dependent  upon  this 
cause.  It  is,  for  example,  the  underlying  factor  in 
many  of  those  mal-adjustments  that  find  their  way 
to  the  juvenile  courts,  the  truancy  officers,  etc.  The 
police  are  meeting  it  at  every  turn.  It  is  essential 
that  all  these  agencies — the  social  worker,  the  after- 
care worker,  the  juvenile  court,  the  psychopathic 
hospital,  the  dispensary,  the  State  hospital,  the  po- 


94  MENTAL  HYGIENE 

lice — should  all  co-operate  and  so  by  preventing 
doubling  on  each  other's  tracks  get  the  greatest 
efficiency  with  the  least  lost  motion. 

The  National  Committee — The  National  Commit- 
tee  for  Mental  Hygiene  with  central  offices  in  New 
York  City,  supported  by  private  funds,  is  conducting 
a  country- wide  movement  with  branches  in  many 
States  (eighteen  at  the  present  writing)  for  the  bet- 
ter care  of  the  insane.  Its  chief  purposes  are; 
* '  To  work  for  the  conservation  of  mental  health ;  to 
promote  the  study  of  mental  disorders  and  mental 
defects  in  all  their  forms  and  relations;  to  obtain 
and  disseminate  reliable  data  concerning  them;  to 
help  raise  the  standards  of  care  and  treatment;  to 
help  co-ordinate  existing  agencies.  Federal,  State 
and  local,  and  to  organize  in  every  State  an  affiliated 
Society  for  Mental  Hygiene. ' '  ^ 

THE   MEANS 

The  means  which  must  be  employed  working 
through  all  these  various  agencies  must  have  three 
large  ends  in  view — The  getting  at  the  individual 
patient  and  his  problems ;  the  getting  at  those  prob- 
lems in  a  broad  enough  way  (his  social  environ- 
ment) so  as  to  be  able  to  help  him;  and  last  but  not 
least,  the  actual  discovery  of  the  patient  in  the  first 

6  Those  who  are  interested  should,  by  all  means,  read  "A  Mind 
That  Found  Itself,"  by  Clifford  W.  Beers  and,  with  more  especial 
reference  to  the  National  Committee,  Part  V  of  the  revised  fourth 
edition  of  that  work  giving  an  account  of  the  origin  and  growth  of 
the  Mental  Hygiene  movement,  which  has  recently  been  published 
as  a  separate. 


THE  INSANE  95 

instance  and  bringing  him  under  such  treatment  (the 
treating  of  the  mentally  ill  as  such  and  not  as  crim- 
inals, paupers,  prostitutes,  etc.). 

1.  Individualization — The  transfer  of  the  mani- 
festly psychotic  patients  from  the  County  farms  to 
the  State  Hospitals  as  the  result  of  the  passage  of 
State  care  acts  and  the  rehabilitation  of  the  State 
Hospitals  did  not  by  any  means  solve  the  whole 
question.  It  changed  the  absolute  neglect  of  the 
County  care  system  to  the  decent  and  kindly  care  of 
the  State  Hospital  but  often  did  little  more  than  this. 
These  institutions  as  soon  as  they  began  to  receive 
patients  from  districts  comprising  several  counties 
began  to  grow,  and  that  growth  continued  and  is 
still  continuing.  From  institutions  of  perhaps  three 
or  four  hundred  patients  they  have  grown  to  have 
three  or  four  thousand — ^huge  caravansaries,  great 
boarding  houses,  but  often  that  was  all.  Perhaps  it 
is  hardly  fair  to  say  that  that  was  all.  These  hos- 
pitals had,  on  the  whole,  well  qualified  medical  staffs 
who  gave  the  patients  good  attention  in  the  matter 
of  their  bodily  ills,  in  fact  so  far  as  there  was  any 
attempt  at  formulation  of  the  medical  problem  it  was 
well  expressed  by  mens  sana  in  corpore  sano.  As- 
tounding as  it  may  seem  to  us  today  it  never  seemed 
to  occur  to  any  one  to  tackle  the  problem  from  the 
psychological  side. 

Under  these  circumstances  it  was  but  natural  that 
the  great  hospitals  should  grow  towards  perfection 
of  sanitary  and  hygienic  equipment,  should  deal  with 
bodily  illness  as  it  was  the  habit  of  the  doctor  to  deal 


96  MENTAL  HYGIENE 

with  it,  but  as  to  the  problems  of  the  mind  should 
deal  with  them  en  masse  and  purely  from  an  ex- 
pediency standpoint.  Patients  who  were  filthy  were 
put  together,  patients  who  were  noisy  were  put  to- 
gether, patients  who  could  have  parole  were  put 
together,  etc.,  etc.,  and  the  matter  rested  there. 
This  was  the  state  of  affairs  that  confronted  the  new 
scientific  era  in  the  care  of  the  insane,  while  the 
advances  in  psychology  which  had  meanwhile  been 
made  made  it  clear  that  the  therapeutic  approach  to 
the  psychoses  must  be  exquisitely  individual.  The 
principle  is  plain;  the  psychotic  patient  is  as  much 
entitled  to  have  his  delusional  system  treated  with 
detailed  care  and  intelligence  as  is  the  general  hos- 
pital patient  entitled  to  have  his  broken  leg  treated 
in  that  way.  This  statement  sounds  axiomatic  but 
if  a  patient  has  the  idea  that  electricity  is  being 
^'turned  on"  him  or  that  he  is  being  "doped"  or 
he  is  suicidal,  the.  question  is,  What  are  you  going 
to  do  about  it?  The  old  answer  was  to  treat  any 
bodily  ill  that  might  be  present  and  so  get  them  in 
as  good  physical  health  as  possible  and  watch  them 
to  see  that  they  did  no  harm. 

The  reason  for  the  failure  in  the  past  to  deal  even 
intelligently  with  the  psychoses  is  quite  evident  as 
already  indicated;  in  the  psychosis  the  patient  not 
only  withdraws  from  reality  but  tends  to  build  up  an 
artificial,  a  phantasy  world  in  which  he  can  live. 
This  phantasy  world  is  not  the  world  you  and  I  live 
in  and  so  the  language  and  the  acts  of  the  patient 
appear  strange  to  us,  we  cannot  underste,nd  them. 


THE  INSANE  97 

It  has  been  just  as  essential  to  learn  the  language  of 
the  psychoses  as  it  is  to  learn  the  language  of  bodily 
disease,  the  meaning  of  being  ''doped"  must  be 
fathomed  in  order  to  do  anything  about  it,  just  as 
the  meaning  of  an  albuminuria  must  be  worked  out 
if  we  are  going  to  intelligently  advise  our  patient. 
The  language  of  the  psychosis  is  symbolic  just  as  is 
the  language  of  internal  medicine — a  broken  cardiac 
compensation  is  homologous  to  a  delusional  system. 

Now  in  the  nature  of  things  every  one  cannot  read 
or  even  learn  to  read  this  strange  language,  just  as 
every  one  cannot  become  a  great  surgeon.  The 
problem,  however,  narrows  down,  how  to  get  the  in- 
dividual sized  up,  dealt  with,  treated  in  accordance 
with  what  is  the  real  trouble  with  him. 

This  problem  is  being  met  in  several  ways;  by 
larger  staffs ;  by  better  equipped  staffs  as  the  med- 
ical colleges  are  beginning  to  teach  psychiatry;  by 
enlarging  the  medical  staffs  by  the  appointment  of 
men  who  have  little  or  no  administrative  work  to  do 
but  occupy  their  whole  time  in  scientific  work  (path- 
ologist, histopathologist,  serologist,  psychologist, 
clinical  director,  scientific  director,  clinical  psychia- 
trist, psychotherapist).  The  hospital  population  is 
thus  gradually  being  broken  up  into  smaller  units  so 
as  to  bring  the  individual  problem  of  the  patient 
ever  closer  to  the  surface. 

Another  healthy  change  is  taking  place,  namely,  a 
change  in  the  attitude  of  psychology  towards  the 
problems.  Academic  psychology  had  little  interest 
in  the  individual  and  less  interest  in  what  might  be 


98  MENTAL  HYGIENE 

troubling  him.  The  fact  that  a  man  got  into  a  quar- 
rel with  his  wife  over  what  appeared  to  be  a  trifling 
matter  was  none  of  its  affair.  Modern  psychology, 
however,  is  beginning  to  see  that  such  problems  have 
importance  and  to  dignify  them  with  its  attention 
because  after  all  it  is  the  multitude  of  little  things 
that  are  happening  all  day  every  day  that  make  up 
the  life  of  the  average  person  and  not  the  unusual 
and  occasional,  if  perhaps,  more  striking  events.  If 
psychology  is  ever  to  make  a  lasting  contribution  to 
the  art  of  right  living  it  must  occupy  itself  with  just 
such  problems.  And  when  we  come  to  take  up  a 
discussion  of  their  lives  with  our  patients  we  will 
find  that  outwardly  while  they  may  have  appeared 
commonplace,  that  within  they  were  the  host  of  a 
conflict  that  was  tearing  them  asunder. 

The  original  method  of  dealing  with  the  insane, 
as  I  have  already  set  forth,  was  born  of  ignorance, 
fear  and  superstition.  The  main  effort  of  this  pe- 
riod was  to  remove  the  insane  person  from  the  com- 
munity, to  segregate  him  in  an  asylum.  Then  fol- 
lowed the  period  of  philanthropy  in  which  kindness 
replaced  cruelty  and  the  insane  person  was  regarded 
as  being  a  sick  person.  Then  began  the  scientific 
era  in  which  the  asylums  were  changed,  in  name  at 
least,  to  hospitals,  and  the  effort  was  made  to  deal 
with  the  mentally  sick  just  as  patients  sick  of  bodily 
disease  were  dealt  with  in  general  hospitals.  In  this 
period  the  patient  was  treated  in  bed,  his  tempera- 
ture, pulse  and  respiration  were  carefully  taken  and 
studied ;  special  dietaries  were  prescribed,  and  effort 


THE  INSANE  99 

was  made  to  search  out  any  bodily  ailment  from 
which  he  was  suffering.  To  this  end  pathological 
laboratories  were  established  for  the  studying  of  the 
dead  material  and  also,  later,  for  studying  the  urine, 
blood,  etc. — clinical  pathology.  And  very  impor- 
tant, training  schools  for  nurses  were  established  to 
help  the  physicians  in  their  work.  The  recent  move- 
ment in  diversional  occupation  therapy  has  been 
along  the  same  lines,  and  while  very  valuable  and 
tending  toward  individualization  has  not  attained  it. 
These  things  were  all  necessary  pre-conditions  for 
the  final  scientific  study  of  the  illness  as  a  mental 
illness  rather  than  necessarily  as  a  manifestation  of 
bodily  disease.  All  these  changes  were  taking  place 
slowly  so  that  when  psychology  was  ready  to  ap- 
proach the  problem  in  the  way  in  which  I  have 
indicated  the  way  was  prepared  for  it. 

2.  The  Social  Setting — In  the  old  hospital  there 
was  a  general  recognition  of  the  principle  that  one 
of  the  benefits  of  hospital  segregation  was  that 
the  patient  was  removed  from  the  circumstances 
under  which  the  psychosis  developed.  The  new  psy- 
chology is  beginning  dimly  to  recognize  that  the 
psychosis  is  originally  a  failure  in  the  individual- 
society  relation  and  as  such  demands  a  study,  not 
only  of  the  individual  as  such  but  of  the  relation. 
To  this  end  social  workers  specially  trained  for  this 
type  of  inquiry  are  beginning  to  develop.  Sent  out 
from  the  hospital  they  are  able,  from  first  hand  in- 
vestigation, to  throw  light  upon  the  actual  family 
and  social  setting  in  which  the  psychosis  developed. 


100  MENTAL  HYGIENE 

and  often  can  materially  assist  in  readjustments  pre- 
paratory to  discharge  from  the  hospital. 

This  sort  of  social  work  has  been  of  great  use  in 
examining  into  the  social  conditions  of  patients  re- 
cently admitted;  in  helping  to  make  readjustments 
for  those  just,  or  about  to  be,  discharged;  and  in 
doing  research  work  and  following  out  special  lines 
of  inquiry. 

3.  Finding  the  Patient — This  even  has  to  be  done 
in  the  hospital  itself  for  with  the  immense  number  of 
patients  the  individual  patient  tends  to  get  lost  in 
the  shuffle  unless  something  unusual  attracts  atten- 
tion to  him.  So  many  patients  are  of  the  ''shut  in" 
type  and  naturally  eliminate  themselves  by  making 
no  requests,  accepting  everything,  being  content 
with  being  overlooked,  that  in  the  hurry  of  pressing 
activities  they  succeed  in  getting  side-tracked.  Of 
course  in  a  way  this  is  what  they  want,  but  it  is  not 
really  what  they  want  either,  and  it  becomes  neces- 
sary to  create  some  method  of  reaching  such  pa- 
tients. 

I  believe  that  the  hospital  should  have  one  or  more 
psychotherapists  against  the  day  when  every  psy- 
chiatrist shall  be  trained  in  psychotherapy.  Even 
with  this  equipment  many  patients  will  not  be 
reached.  I  am  trying  now,  by  means  of  an  intra- 
mural publication,  a  sort  of  newspaper,  to  create  a 
more  helpful  spirit  of  co-operation  between  medical 
officer  and  patient  with  this  end  in  view,  among 
others,  of  getting  the  ' '  shut  in ' '  patient  on  the  back 
wards  to  come  forward  and  ask  for  help. 


THE  INSANE  101 

Aside  from  this  problem  there  is,  of  course,  the 
very  large  problem  of  getting  the  mentally  ill  cared 
for  as  such,  no  matter  where  they  may  be.  This 
necessitates  their  recognition  and  also  the  creation 
of  agencies  for  their  recognition  and  the  ability  of 
such  agencies  to  carry  their  point.  At  present,  in 
the  ceaseless  grind  of  our  courts,  hundreds  of  thou- 
sands of  human  beings  are  consigned  to  one  or 
another  sort  of  penal  institution  every  year  for  no 
other  reason  than  because  they  are  mentally  ill. 
This  only  serves  to  make  the  sick  sicker,  and  from 
every  point  of  view  is  a  wasteful,  senseless,  unin- 
telligent method  of  procedure  that  brings  good  to 
no  one  and  harm  to  many.  I  will  have  more  to  say 
of  this  aspect  of  the  question  in  later  chapters,  par- 
ticularly the  next.  Fully  fifty  per  cent.,  and  prob- 
ably more,  of  the  so-called  criminals  are  mentally 
ill,  about  fifty  per  cent,  of  the  prostitutes  who  come 
within  the  purview  of  the  criminal  courts,  and  prob- 
ably as  large  or  a  larger  per  cent,  of  juvenile  offend- 
ers. Until  it  is  learned  to  treat  these  persons  for 
what  they  are  and  not  for  something  else  very  little 
progress  can  be  expected  in  solving  the  problems  to 
which  they  give  rise. 

THE   METHODS 

It  will  thus  be  seen  that  the  problem  of  mental 
disease  is  a  large  one  and  far-reaching.  It  is  a 
problem  which  has  never  been  adequately  attacked 
from  the  standpoint  of  preventive  medicine,  and  yet 
it  is  one  which  economically  is  of  the  greatest  im- 


102  MENTAL  HYGIENE 

pottance,  because  no  class  of  people  in  the  com- 
munity probably  cost  more  in  dollars  and  cents  to 
care  for  than  the  so-called  insane.  As  it  is  at  pres- 
ent, however,  mental  disease  goes  largely  unrecog- 
nized, not  only  so  far  as  our  public  hospitals  are 
concerned,  but  so  far  as  a  large  number  of  the  prac- 
titioners of  medicine  are  concerned,  and  no  effort  is 
made  to  help  incipient  cases  previous  to  a  frank  out- 
crop of  symptoms,  which  makes  their  incarceration 
necessary.  In  fact,  these  people  have  no  place  to  go, 
except  in  rare  instances,  where  they  may  get  intelli- 
gent advice,  and  so  the  problem  is  not  recognized 
until  it  becomes  self-evident,  and  by  that  same  token 
until  the  period  has  passed  when  treatment  might 
avail. 

It  should  be  clear  to  those  who  are  accustomed  to 
dealing  with  medical  facts  that  the  existence  of 
mental  disease  should  be  recognized  in  a  practical 
manner,  by  admitting  people  for  advice  and  treat- 
ment to  the  various  institutions  conducted  by 
medical  charity  on  the  same  basis  as  patients  are 
admitted  for  treatment  for  other  and,  in  many 
instances,  much  less  important  maladies.  And 
when  I  say  they  should  be  admitted  on  the  same  basis 
as  other  patients,  I  mean  that  the  various  legal  re- 
strictions and  disabilities  from  which  they  are  now 
made  to  suffer  before  they  can  get  anything  like 
adequate  treatment  should  be  removed.  As  it 
stands  today,  the  patient  who  falls  down  on  the 
street  and  breaks  his  leg  not  only  may  receive 
prompt  and  skilful  treatment  in  a  general  hospital 


THE  INSANE  103 

in  the  city  for  the  asking,  but  he  is  almost  taken 
there  willy-nilly,  so  little  is  his  disinclination  to  go 
considered  as  a  possibility.  The  patient  who  is  suf- 
fering, so  to  speak,  from  a  broken  mind,  however, 
has  no  place  to  go.  The  general  hospitals  would  not 
take  him  if  they  could,  for  they  have  no  means  to 
handle  such  cases  and  if  they  did  they  have  no  un- 
derstanding of  nor  any  interest  in  the  problems  in- 
volved, and  there  is  nothing  left  for  the  patient  to 
do  but  to  seek  admission  through  the  tedious  and 
humiliating  process  of  the  law,  which  brands  him, 
in  addition  to  his  mental  disability,  with  a  legal  dis- 
ability before  he  is  permitted  to  receive  relief. 
What  wonder  is  it  that  neither  the  patient  nor  the 
patient's  relatives  seek  for  the  relief  until  it  is  too 
late  ?  What  wonder  is  it  that  they  should  draw  back 
and  hesitate  to  ask  when  their  request  is  granted 
with  such  poor  grace  ? 

It  is  self-evident,  therefore,  that  the  mentally  sick 
should  be  permitted  the  same  rights  of  treatment 
for  their  several  illnesses  as  the  physically  sick,  that 
they  should  be  accorded  the  same  consideration,  and 
that  the  hospitals  of  the  various  cities  should  be 
prepared  to  receive,  care  for,  and  intelligently  treat 
them.  The  subject  of  mental  medicine,  however,  is 
a  distinct  specialty,  and  it  requires  close  application 
and  study  for  years  to  master  its  principles,  and 
therefore  it  is  natural  that  a  portion  of  the  hospitals 
should  be  set  aside  for  these  cases,  the  wards  to  be 
in  charge  of  specially  trained  psychiatrists  just  as 
separate  portions  of  the  hospital  are  set  aside  for 


104  MENTAL  HYGIENE 

other  purposes — medical,  surgical,  obstetrical,  or 
what  not,  with  their  respective  specially  trained  men 
in  the  problems  involved.  This  means  that  some- 
where in  a  city  of  any  considerable  size  there  should 
be  wards  specially  designed  and  maintained  for  the 
receipt  of  patients  suffering  from  mental  disease. 
Such  wards  are  usually  called  psychopathic  wards, 
psychopathic  clinics,  or  psychopathic  hospitals. 
They  may  be  organically  connected  with  the  general 
hospital;  they  may  occupy  an  isolated  position  at 
some  distance  from  the  rest  of  the  institution ;  they 
may  be  separate  institutions  altogether ;  or  they  may 
be  constructed  separately,  but  in  association  with 
the  other  buildings  of  a  large  general  hospital. 

Which  of  the  several  plans  suggested  above  is  the 
most  desirable  is  almost  always  a  matter  which  has 
to  be  considered  on  the  merits  of  the  local  situation. 
Our  American  cities,  with  their  rapid  patchwork 
growth,  often  present  problems  that  make  any  solu- 
tion necessarily  a  compromise.  The  ideal  arrange- 
ment, it  would  seem  to  me,  is  for  the  city  to  have  a 
municipal  hospital  located  not  too  near  the  heart  of 
the  city  and  not  too  far  away  to  be  accessible,  but  on 
ground  sufficiently  extensive,  not  only  for  the  pres- 
ent purposes  of  the  hospital,  but  for  all  reasonable 
future  growth.  The  plans  of  such  an  institution 
should  include  a  psychopathic  ward. 

The  advantages  of  such  an  arrangement  are  mani- 
fold. In  the  first  place,  the  patient  goes  primarily 
to  the  big  municipal  hospital ;  he  goes  to  the  medical 
ward  if  he  has  pneumonia,  he  goes  to  the  surgical 


THE  INSANE  105 

ward  if  lie  has  appendicitis,  and  he  goes  to  the 
psychopathic  ward  if  he  has  mental  disease.  He 
feels  in  this  environment  the  influence  of  the  hos- 
pital atmosphere,  he  is  where  he  belongs,  he  is  in  an 
institution  conducted  for  the  care  of  sick  people,  and 
this  feeling  would  be  doubly  strong  if  the  municipal- 
ity in  its  wisdom  could  be  induced  to  withdraw  the 
disabling  legal  preliminaries.  Then,  again,  his  rel- 
atives feel  more  at  peace  about  him  when  he  is  here 
in  this  big  hospital  than  they  would  if  he  were 
legally  committed  to  an  insane  asylum.  The  mu- 
nicipality is,  on  the  face  of  it,  endeavouring  to  treat 
a  sick  man,  and  not  simply  to  shut  up  a  crazy  one. 
It  is  the  logical,  the  humane  approach,  and  not  the 
legal,  disabling  method  of  turning  the  back  to  a 
disagreeable  problem  and  locking  the  door. 

In  addition  to  the  advantages  of  an  arrangement, 
as  described  above,  for  the  patient  and  the  patient's 
relatives,  there  are  other  advantages.  In  the  first 
place,  the  mental  cases  throughout  the  big  general 
hospitals  can  be  taken  where  they  belong,  just  as, 
for  example,  if  a  woman  is  brought  into  the  medical 
ward  vomiting,  and  examination  shows  that  she  is 
pregnant  and  that  the  vomiting  is  the  result  of  her 
pregnancy,  she  may  be  transferred  to  the  obstetrical 
ward,  where  she  will  receive  the  best  care  and  treat- 
ment for  the  particular  condition  from  which  she  is 
suffering;  so  the  mental  cases  in  a  general  hospital 
will  go  to  the  psychopathic  pavilion,  where  they  will 
receive  the  best  care  and  treatment.  In  addition  to 
that,  the  psychopathic  ward,  with  its  corps  of  trained 


106  MENTAL  HYGIENE 

men,  will  be  at  the  call  of  the  other  departments  of 
the  hospital.  Every  patient  in  the  institution,  in 
addition  to  the  trained  advice  of  physicians  and 
surgeons  in  all  the  different  departments  of  medi- 
cine, will  have  added  to  the  list  of  men,  on  whom  he 
can  draw  to  help  him  in  case  he  needs  it,  a  psychia- 
trist. 

This  introduction  of  the  psychiatrist  into  the  gen- 
eral hospital  is  to  my  mind  filled  with  the  greatest 
possibilities  for  medicine.  We  have  always  met  on 
the  medical  and  surgical  wards  the  neurasthenic  and 
the  hysteric,  but  how  rare  it  has  been  through  the 
years  that  most  of  us  have  lived  to  see  such  cases 
treated  intelligently,  not  to  say  sympathetically  or 
understandingly.  But  the  hysteric  and  the  neuras- 
thenic and  such  other  patent  conditions  are  by  no 
means  the  only  ones  in  which  the  psychiatrist  can 
be  of  inestimable  service  to  the  internist  and  the 
internist  can  be  of  inestimable  service  to  the  psy- 
chiatrist. There  is  literally  a  host  of  conditions  that 
lie  on  the  borderland  between  internal  medicine  and 
psychiatry.  To  mention  one  only,  there  is  that  im- 
mense group  of  fever  deliria,  of  which  every  hospital 
has  innumerable  cases  at  all  times.  The  fever  de- 
liria will,  no  doubt,  some  day,  throw  a  great  deal  of 
light  on  the  functions  of  the  higher  nervous  centres, 
to  say  nothing  of  the  possibilities  on  the  organic 
side.  In  addition  to  this  immense  group  of  the 
fever  deliria,  there  are  hosts  of  other  cases  where 
internal  medicine  and  psychiatry  must  needs  meet, 
and  the  sooner  the  better.    There  are,  to  mention 


THE  INSANE  107 

only  a  few,  the  traumatic  deliria  and  post-tranmatic 
defect  states  of  various  sorts;  the  post-operative 
psychoses ;  psychoses  from  shock,  loss  of  blood ;  the 
group  that  follow  operations  on  the  eye  and  long 
confinement  in  a  dark  room;  that  very  large  group 
of  gastrointestinal  cases  that  have  close  relation- 
ships with  the  neuroses,  which  are  at  present  not 
understood,  but  which  are  possibly  mediated  through 
the  endocrinous  glands  and  the  sympathetic  nervous 
system.  Then  there  is  the  group  of  pelvic  diseases 
in  women.  No  one  who  knows  anything  about  the 
history  of  medicine  in  the  past  generation  can  doubt 
but  that  thousands  of  ovaries  have  been  removed, 
not  to  mention  more  grave  operations,  when  the 
disease  was  not  in  the  pelvis  at  all,  but  was  in  the 
mind.  Then  there  are  the  chronic  organic  nervous 
conditions,  the  hemiplegias,  with  the  aphasias, 
apraxias,  and  organic  deteriorations ;  and  finally  the 
large  group  of  toxic  psychoses,  among  which  alcohol 
plays  the  greatest  part.  All  of  this  immense  class 
of  cases  constitute  a  proper  field  for  the  psychia- 
trist, and  the  psychiatrist  and  the  internist  working 
together  is  the  ideal  toward  which  the  establishment 
of  the  psychopathic  ward  in  a  general  hospital  will 
lead. 

Of  the  various  classes  of  cases  which  have  been 
briefly  mentioned  above,  the  alcohoKc  and  drug  cases 
should  be  under  the  immediate  care  of  the  psychia- 
trist, either  in  the  psychopathic  pavilion  itself  or  in 
an  adjoining  pavilion  under  his  supervision.  The 
general  problem  of  the  alcoholic  must  necessarily 


108  MENTAL  HYGIENE 

meet  its  solution  in  the  psychiatrist's  hands.  It  is 
true  that  the  physical  conditions  are  often  most 
prominent  and  perhaps  require  the  most  intensive 
treatment.  A  neuritis  of  the  phrenic  nerve,  for  ex- 
ample, is  of  course  not  primarily  a  matter  for  the 
psychiatrist,  but,  taking  the  problem  as  a  whole,  it 
belongs  in  his  domain.  Patients  that  are  admitted 
are  admitted  almost  invariably  because  of  some  dis- 
turbances of  conduct.  They  are  either  delirious, 
hallucinated,  or  deluded  in  an  active  way  which  leads 
to  their  arrest,  or  to  apprehensiveness  or  complaint 
on  the  part  of  some  one  associated  with  them.  In 
addition  to  this,  many  of  them  have  actually  com- 
mitted some  overt  act,  perhaps  homicide,  and  it  is 
important  that  when,  under  these  circumstances,  a 
patient  is  brought  to  the  hospital  he  should,  at  the 
earliest  possible  moment,  be  placed  under  the  obser- 
vation of  those  who  are  trained  to  deal  with  mental 
questions  in  their  legal  bearings  in  connection  with 
the  administration  of  the  criminal  law. 

In  addition  to  all  the  above,  and  flowing  naturally 
and  inevitably  from  the  conclusions  reached,  I  be- 
lieve that  the  general  hospital  should  maintain  an 
out-patient  department  for  the  advice  and  treatment 
of  persons  with  mental  disease.  With  such  a  ma- 
chinery attached  to  the  municipal  hospital,  there  is 
no  reason  why  all  who  are  afflicted  cannot  as  readily 
seek  aid  as  those  with  bodily  disease.  The  details 
of  transfer  from  the  psychopathic  ward  to  the  larger 
state  institutions  should  be  made  as  simple  as  pos- 
sible.   Transfer  should  be  made  effective  on  a  cer- 


THE  INSANE  109 

tificate  of  two  properly  qualified  physicians,  and 
the  matter  should  not  have  to  come  into  court  at  all 
unless  it  is  brought  there  by  the  patient,  his  rela- 
tives, or  some  friends  on  his  behalf.  I  would  not 
close  the  courts  to  the  so-called  insane  by  any  means, 
but  I  would  not  insist  on  a  legal  process,  whether 
the  patient  wanted  it  or  not ;  I  would  not  insist,  so 
to  speak,  on  cramming  an  alleged  constitutional 
right  down  the  patient 's  throat  at  the  expense  of  his 
life.  We  see  today  this  process  of  commitment  go- 
ing on  where  nobody  wants  it.  The  patient  does 
not  want  it,  the  patient's  friends  and  relatives  do 
not  want  it,  and  anybody  who  stands  and  watches  it 
proceed  recognizes  on  the  face  of  it  that  it  is  a  farce. 
I  would,  therefore,  proceed  to  the  matter  of  com- 
mitment in  the  simplest  way.  Leave  the  courts 
accessible  to  the  patient  if  he  wants  to  appeal  for 
relief,  and  it  will  be  surprising  how  rare  such  ap- 
peals will  be. 

In  the  construction  of  the  psychopathic  ward 
arrangements  should  be  made  and  equipment  pro- 
vided for  all  the  scientific  work  which  modern  science 
demands  in  connection  with  the  proper  diagnosis  and 
treatment  of  the  cases  that  the  psychopathic  ward 
is  called  on  to  deal  with,  and  so  far  as  possible  it 
would  be  best  that  additional  opportunity  should  be 
provided  in  the  way  of  laboratories,  equipment,  and 
fellowships  for  carrying  on  original  research  work. 
Whether  this  latter  is  or  is  not  provided,  it  is  highly 
desirable  that  the  wards  should  be  constructed  with 
a  view  to  teaching  purposes.     The  material  should 


no  MENTAL  HYGIENE 

be  made  accessible  to  the  medical  schools,  and  it 
would  be  the  part  of  wisdom  to  provide  a  capacious 
auditorium  in  which  lectures  might  be  delivered  and 
where  patients  could  be  exhibited.     Such  material 
coming  in  from  a  big  city,  of  all  classes  and  descrip- 
tions, large  numbers  of  acute  cases,  with  access  to 
all  sorts  of  borderland  conditions,  makes  an  invalu- 
able supply  for  the  purposes  of  instruction,  and  if, 
in  addition  to  the  instruction  of  the  medical  student, 
the  law  student  should  have  to  come  there  and  listen 
to  the  lectures  on  mental  medicine,  we  might  per- 
haps work  through  such  an  institution  the  greatest 
of  miracles — a  rational  set  of  statutes,  with  rational 
methods  of  legal  procedure,  where  cases  of  mental 
disease  are  under  consideration.     Such  an  institu- 
tion, so  equipped  and  manned,  would  also  be  the 
rational  place  for  the  courts  to  send  prisoners  await- 
ing trial,  under  sentence,  or  what  not,  in  regard  to 
whom  the  suspicion  of  mental  disease  had  arisen. 
It  is  my  belief  that  such  institutions  should  take  the 
place  of  the  present  method  of  procedure  in  criminal 
cases  in  which  the  claim  of  insanity  is  raised.     Per- 
haps they  should  not  altogether  take  their  place, 
but  they  should  practically  take  their  place.    In  a 
specific  instance  in  which  the  question  of  insanity  is 
under  consideration,  the  prisoner  could  be  sent  to 
the  psychopathic  ward,  held  there  for  observation 
for  a  sufficient  length  of  time,  and  a  careful,  detailed, 
and  scientific  report  made  to  the  court  upon  his  case, 
without  any  alterations  in  our  present  methods  of 


THE  INSANE  111 

procedure  or  theory  of  practice.  Such  a  report 
would  necessarily  carry  tremendous  weight  in  the 
decision  of  the  case.  I  am  not  altogether  in  favour 
of  making  such  a  report  a  legal  document  in  the 
sense  that  it  would  be  controlling  on  the  action  of 
the  court  in  any  way,  but  let  it  go  forward  with  its 
preponderant  weight  of  authority,  and  I  believe  that 
in  the  large  majority  of  cases  it  would  carry  every- 
thing before  it. 

Such  a  psychopathic  ward  as  I  have  described 
above,  adequately  equipped  and  properly  officered, 
with  its  organic  connections  with  a  municipal  hos- 
pital, and  perhaps  also  with  a  university  or  medical 
college,  would  be  a  tower  of  strength  in  the  com- 
munity. It  would  put  mental  medicine  on  a  scien- 
tific basis;  it  would  establish  the  hospital  for  the 
insane  in  the  confidence  of  the  community ;  it  would 
open  its  doors  to  dealing  with  the  mentally  ill  when 
they  needed  help  and  advice,  and  when  treatment 
would  be  beneficial ;  it  would  assist  the  courts  in  the 
administration  of  justice,  and  it  would  assist  the 
sick  man  in  getting  justice;  it  would  bring  mental 
medicine  into  closer,  more  harmonious,  and  more 
organic  relationships  with  internal  medicine  to  the 
mutual  advantage  of  both;  it  would  form  a  nucleus 
for  scientific  research  work  that  could  be  indefinitely 
elaborated;  and,  finally,  it  could  form  a  centre  of 
social  endeavour  of  great  beneficence  in  the  com- 
munity. Not  only  might  it  be  of  value  for  the  social 
worker,  for  the  scientific  eugenicist,  but  it  would  be 


112  MENTAL  HYGIENE 

the  natural  centre  from  which  would  radiate  all 
efforts  at  popular  instruction  in  matters  connected 
with  mental  disease. 

All  these  suggestions  are  simply  in  the  way  of 
insisting  that  mental  sickness  should  be  given  the 
same  kind  of  consideration  as  other  kinds  of  sick- 
ness. Of  course  this  result  cannot  be  brought  about 
in  a  minute.  It  means,  perhaps,  more  than  any- 
thing else  the  education  of  the  physician  in  mental 
medicine.  Today  a  patient  admitted  to  the  hospital 
for  typhoid  fever,  a  broken  leg  or  other  so-called  or- 
ganic physical  disorder  is  given  all  sorts  of  atten- 
tion on  the  physical  side.  Both  cases  are  treated, 
not  only  for  what  they  have  when  they  are  received, 
but  for  what  may  develop  while  in  the  hospital.  For 
example,  the  man  with  a  broken  leg  may  develop  a 
pneumonia  and  is  treated  accordingly.  With  all 
their  complicated  armamentarium,  however,  the 
hospitals  are  not  equipped  to  deal  with  departures 
from  the  normal  in  the  mental  sphere  or  even,  for 
the  most  part,  to  recognize  them.  It  is  only  when 
they  are  forced  upon  the  attention  of  the  attending 
physician  by  some  very  evident  disorder  of  conduct 
such  as  the  unconsciousness  or  delirium  following  a 
head  injury,  the  violence  of  a  pneumonia  delirium, 
a  post  partum  attempt  at  suicide  that  anything  is 
done  and  then  only  that  which  is  forced  in  order  to 
take  care  of  the  practical  situation.  There  is  no 
adequate  appreciation  of  either  the  part  played  by 
the  mind  in  the  causation  of  disease  or  of  the  im- 


THE  INSANE  113 

portance  of  mental  factors  in  maintaining  efficiency 
and  in  making  happiness  possible. 

All  of  these  questions  involving  mental  health  are 
beginning  to  be  asked,  and  there  is  a  decided  move- 
ment in  the  direction  of  an  adequate  consideration 
of  the  mental  factors  of  disease.  We  are  at  present, 
however,  a  long  way  from  this  goal.  We  already 
know  that  many  conditions  which  are  usually  treated 
medically  or  surgically  may  have  a  very  important 
mental  cause,  perhaps  may  be,  at  first  at  least,  alto- 
gether mental  in  origin.  For  example,  the  mental 
factors  of  such  diseases  as  exophthalmic  goitre  and 
diabetes  mellitus  have  never  been  adequately  an- 
alyzed nor  have  the  mental  factors  in  the  various 
viceroptoses  (prolapse  of  the  various  abdominal  or- 
gans) although  in  all  of  these  conditions  they  un- 
doubtedly play  a  large,  perhaps  the  largest  part  in 
some  cases.  We  know  too  that  certain  diseases  are 
voluntarily  acquired  as  partly  or  completely  uncon- 
scious attempts  at  suicide  or  as  equally  unconscious 
ways  of  doing  penance  for  previous  conduct  con- 
ceived of  as  sinful.  We  have  a  fairly  good  realiza- 
tion of  motives  of  self-interest,  often  unconscious, 
in  illness  the  result  of  injury  for  which  suit  is  pend- 
ing and  in  illness  for  which  recovery  is  possible  un- 
der insurance  or  liability  acts.  All  of  these  are 
matters  of  great  importance  as  bearing  upon  the 
mental  factors  involved  and  also  as  bearing  upon 
the  larger  individual-society  relation. 

Before  any  of  the  myriad  problems  of  such  types 


114  MENTAL  HYGIENE 

will  receive  adequate  attention  it  must  be  brought 
about  that  the  average  physician  will  take  as  much 
interest  in,  pay  as  much  attention  to,  his  patient's 
psyche  as  he  does  to  a  great  many  other,  often  far 
less  important,  matters.  Of  course  I  do  not  mean 
by  this  that  every  physician  should  be  a  psychiatrist 
but  he  should  have  had  as  much  instruction  about 
psychological  types  of  reaction  as  he  had  about  the 
other  types  of  reaction.  He  should  have  had  some 
instruction  in  the  fundamental  principles  of  human 
behaviour.  Every  physician,  for  example,  is  not 
equipped  nor  is  he  capable  of  making  an  examina- 
tion of  the  heart  according  to  present  day  standards, 
but  he  should  know  enough  about  heart  disorders  to 
know  when  to  send  his  patient  to  a  heart  specialist. 
Similarly,  every  physician  should  know  enough  of 
conduct  disorders  to  know  when  to  call  the  psychia- 
trist. When  there  begins  to  be  a  general  apprecia- 
tion of  the  importance  of  the  mental  in  medicine 
then  we  may  begin  to  look  forward  to  the  day  when 
there  will  be  a  general  understanding  of  a  mental 
as  of  a  somatic  sign  or  symptom.  The  heart  special- 
ist can  read  the  various  curved  lines  on  a  strip  of 
paper  that  record  the  action  of  the  different  portions 
of  the  heart.  These  symbols,  to  those  who  have 
studied  them,  are  full  of  meaning.  Why  should  not 
the  delusion,  expressed  by  the  symbols  "I  am  being 
doped"  yield  just  as  much  meaning  to  the  specially 
trained  psychiatrist. 

In  the  meantime  it  is  important  that  the  hospitals 
for  the  care  and  treatment  of  the  mentally  ill  should 


THE  INSANE  115 

come  to  realize,  and  that  at  an  early  date,  that  they 
are  not  only  dealing  with  disorders  at  the  psycho- 
logical level  but  that  the  disturbances  of  adjustment 
at  this  level  must  be  approached  by  a  therapeutics 
which  is  aimed  primarily  at  the  psyche.  Not  that 
somatic  disturbances  should  be  neglected  but  that 
psychotherapeutics  should  be  recognized  as  of  para- 
mount importance.  The  ideal  here  is  that  the  pa- 
tient with  a  psychosis  should,  when  received  in  the 
hospital,  have  the  same  interest  and  attention  paid 
to  his  mental  symptoms  as  the  physically  ill  patient 
has  paid  to  his  somatic  symptoms  in  a  general  hos- 
pital, and  that  the  same  degree  of  intensive  thera- 
peutic effort  should  be  addressed  to  his  mental 
disease  based  upon  these  symptoms  as  is  directed  to 
the  relief  of  physical  illness  based  upon  somatic 
symptoms.  This  requires,  of  course,  a  degree  of 
individualization  of  the  patients  which  with  present 
equipment  and  with  present  knowledge  is  not  pos- 
sible, but  it  should  be  the  goal  towards  which  eif  orts 
were  clearly  and  consistently  directed. 

Take  for  example  the  movement  for  occupation  of 
patients.  This  has  everything  to  commend  it  al- 
though I  confess  I  do  not  altogether  like  the  name  it 
so  frequently  goes  under  of  ' '  diversional  occupa- 
tion." The  effort  should  be,  and  really  is,  more 
serious  than  the  qualification  indicates.  I  should 
prefer  that  it  be  designated  as  occupational  therapy. 
Such  therapy  should  be  primarily  addressed  to  the 
individual  needs  of  the  patient,  first  to  help  him 
overcome  his  psychological  difficulties  (his  psycho- 


116  MENTAL  HYGIENE 

sis)  and  secondly,  if  possible,  lie  should  be  given 
such  work  as  he  may  use  when  discharged  to  help 
support  himself — ^to  re-establish  his  social  relations. 
Such  specific,  individual  treatment  is  not  now  often 
possible  but  it  should  be  the  aim. 

The  aim  of  the  hospital  should  be,  of  course,  to  get 
the  patient  well  and  to  turn  him  back  into  the  com- 
munity a  useful  citizen.  In  this  however,  the  hos- 
pital must  often  fail.  The  capacity  of  many  a 
patient  is  not  equal  to  an  independent  social  exist- 
ence. For  such  patients  the  hospital  must  create 
an  environment  in  which  they  can  live  and  too  at 
their  maximum  efficiency.  Living  at  their  maxi- 
mum efficiency  is  not  only  best  for  them  but  it  is  best 
for  society  too,  because  they  are,  under  such  circum- 
stances, of  their  maximum  value  to  the  herd. 

These  then  are  the  two  fundamental  functions  of 
the  hospital.  To  get  the  patient  well,  or  failing  in 
that  to  create  an  environment  for  him  that  will  per- 
mit him  to  live  at  his  maximum  efficiency. 

SUMMARY 

The  insane  are  a  group  of  socially  inadequate  per- 
sons who  suffer  from  a  great  variety  of  mental  dis- 
orders. 

In  order  that  the  problem  of  the  insane  may  be 
intelligently  met  it  must  be  approached  from  the 
standpoint  of  mental  pathology. 

The  standpoint  of  mental  pathology  demands  that 
the  psychological  reactions  be  given  as  much  con- 


THE  INSANE  117 

sideration  as  other  reactions.  This  involves  im- 
proved medical  education. 

Giving  full  value  to  mental  disorders  would  mean 
that  they  would  be  recognized  wherever  they  were 
and  be  treated  as  such. 

The  hospitals  for  mental  disease  need  to  recog- 
nize that  these  diseases  require  a  psychotherapeutic 
approach  and  intensively  individual  treatment. 

Various  social  agencies  will  find  the  mentally  ill 
before  they  are  so  sick  as  to  be  at  once  recognized 
and  sent  to  a  hospital;  other  agencies  will  help  the 
discharged  patient  re-establish  and  re-adjust  where 
necessary  his  social  relations. 

The  dispensary  and  practicing  physicians  will 
recognize  and  treat  incipient  disorders  of  adjust- 
ment at  the  psychological  and  social  level  and  pre- 
vent many  serious  breakdowns  that  would  otherwise 
require  hospital  treatment. 


CHAPTER  V 
THE  CRIMINAL 

THE   CONCEPT    CEIMINAL 

Before  we  can  deal  intelligently  with  the  social 
group  to  which  the  term  "criminal"  has  been  ap- 
plied we  must  first,  as  in  the  last  chapter  on  the 
''insane,"  examine  the  concept  and  see  what  it  in- 
cludes. 

Just  as  we  have  seen  in  the  last  chapter  in  con- 
sidering the  word  "insane"  so  we  see  here  that 
"criminal"  can  only  mean  one  who  has  been  pro- 
nounced by  "due  process  of  law"  guilty  of  an 
offence  which  the  law  declares  to  be  a  crime.  And 
a  crime  is  a  given  form  of  conduct  which,  as  defined, 
is  specifically  prohibited  by  statute.  In  other  words, 
the  law  proceeds  to  say  that  the  doing  of  such  and 
such  acts  shall  constitute  a  crime  and  then,  if  in 
the  opinion  of  a  jury,  a  given  person  has  done  one 
of  these  proscribed  acts  he  thereby  becomes  a  crim- 
inal. 

We  thus  see  that  the  concept  "criminal"  like  the 
concept  "insane"  is  a  purely  legal  and  sociological 
concept.  To  classify  persons  as  criminals  tells  us 
absolutely  nothing  about  them,  it  rather  only  tells 
us  of  society's  attitude  towards  them.  Take,  for 
example,  the  more  limited  concept  of  "thief."    One 

118 


THE  CRIMINAL  119 

man  may  steal  under  the  influence  of  the  prodromal 
stage  of  paresis  although  previously  of  high  moral 
character ;  another  man  may  steal  under  the  excite- 
ment of  a  hypomanic  attack ;  another  as  a  result  of 
moral  delinquency ;  another  as  a  result  of  high  grade 
mental  defect;  another  under  the  influence  of  alco- 
holic intoxication,  and  so  on  indefinitely.  It  must 
be  perfectly  evident  from  such  an  illustration  that 
one  should  not  expect  anything  in  common  among 
the  members  of  such  a  group  just  because  the  out- 
ward act  was  such  that  a  jury  might  conclude  that 
it  came  within  the  statutory  definition  of  larceny. 
As  little  expect  all  people  who  had  fever  to  be  other- 
wise alike,  or  all  people  engaged  in  the  automobile 
business  to  present  traits  in  common  sufficient  to 
constitute  them  a  distinct  anthropological  group. 

We  can  never  learn  much  about  mankind  in  its 
different  aspects  by  studying  such  heterogeneous 
groups  as  the  criminal  is  thus  seen  to  be.  The  diffi- 
culty with  all  such  methods  of  approach  to  scientific 
problems  is  that  the  approaches  are  not  sufficiently 
controlled  by  dynamic  concepts.  A  group  of  indi- 
viduals, as  in  this  case,  is  given  a  name,  and  forth- 
with the  name  becomes  a  thing,  and  the  thing  has 
clear-cut,  rigid  limitations,  and  is  dealt  with  as  such. 
Then  the  first  thing  we  know  some  one  is  measuring 
up,  by  aU  sorts  of  both  physical  and  mental  stand- 
ards, the  members  of  the  group,  in  this  case  all 
thieves,  for  instance,  and  as  a  result  we  are  told  just 
the  characteristics  of  a  thief,  in  the  abstract,  as  if 
there  were  any  such  thing.     Suppose  the  weight  of 


120  MENTAL  HYGIENE 

an  elephant,  a  mouse,  an  eagle,  a  bat,  a  whale,  a  lake 
trout,  and  a  lamprey  eel  are  averaged.  The  result 
is  a  mathematical  fact,  but  does  not  correspond  to 
any  living  thing,  bird,  beast  or  fowl,  on  the  earth, 
in  the  heavens  above  the  earth,  or  in  the  waters  be- 
neath. What  use  is  it?  Perhaps  by  studying  crim- 
inals individually  we  may  come  to  sort  out  groups, 
but  never  by  studying  them  that  way,  the  way  of  the 
artificial  groupings  defined  and  created  by  the  law. 
The  criminal,  after  all,  is  only  a  person  who  has  been 
found  guilty,  whose  conduct  has  been  passed  upon 
by  a  jury,  and  who  has  thus  come  to  be  legally 
labelled.  A  fundamentally  dynamic  viewpoint  of 
human  beings  should  enable  one  to  see  them  as  bio- 
logical units  in  the  last  analysis,  but  not  any  too 
clearly  differentiated  from  their  environment. 
They  should  be  viewed  as  integral  parts  of  the 
social  organism  and  we  need  to  study  the  interplay 
of  action  and  reaction  between  what,  at  their  focal 
points,  we  term  the  individual  and  the  environment.^ 

THE   NATURE   OF    CRIMINAL   CONDUCT 

I  have  said  in  the  last  chapter  that  the  insane  were 
a  group  of  socially  inadequate  persons  who  were 
separated  off  from  the  community  but  upon  whom 
the  community  looked  with  leniency  and  sympathy, 
and  thought  of  them  as  suffering  from  mental  dis- 
ease and  therefore  as  irresponsible.  Now  the  crim- 
inal on  the  other  hand,  although  he  too,  manifests 

1  See  the  author's  "Individuality  and  Introversion,"  Thfi  Psycho- 
analytic Review,  January,  1917. 


THE  CRIMINAL  121 

a  socially  inadequate  type  of  conduct,  conduct  wMch 
cannot  be  assimilated  by  the  herd,  and  although  he 
too,  is  separated  off  from  the  community,  he  is 
looked  upon  by  that  community  quite  differently. 
He  is  not  considered  leniently  and  with  sympathy 
but  harshly,  in  fact  with  hate,  and  he  is  held  as 
responsible  for  his  acts  and  accordingly  punished 
for  them,  that  is,  is  made  to  suffer  pain.  With  both 
classes,  therefore,  the  "insane"  and  the  "criminal" 
we  see  we  are  dealing  with  socially  inadequate  con- 
duct, and  whether  a  given  individual  is  called  "in- 
sane" or  "criminal"  is  the  result,  not  so  much  of 
any  particular  quality  or  characteristic  which  he 
may  possess,  but  is  rather  the  result  of  the  way  in 
which  the  community  comes  to  regard  him,  either 
with  sympathy  (love)  or  hate.  In  other  words,  in- 
sanity and  criminality  are  not  inherent  in  the  indi- 
viduals as  such,  but  are  rather  projected  upon  them 
by  the  community,  they  are  forms  of  herd  critique. 
They  are  labels  which  society  applies  to  individuals 
whose  conduct  comes  within  certain  categories  which 
society,  by  means  of  its  law-making  function,  at- 
tempts to  define. 

Perhaps  we  can  gain  an  inkling  of  how  this  state 
of  affairs  has  come  about  if  we  examine  somewhat 
the  nature  of  sympathy  and  hate.  Sympathy,  of 
course,  is  a  variant  of  love.  It  is  that  form  of  love 
for  another  which  is  possible  because  we  can  think 
and  feel  like  that  other,  because  we  can,  to  use  the 
popular  phrase,  put  ourself  in  his  place.  We  are 
able  to  see  things  as  they  see  them  because  we  can. 


122  MENTAL  HYGIENE 

so  to  speak,  look  through  their  eyes.  We  feel  with 
the  other  person,  we  respond  to  his  situation  with 
feelings  of  the  same  kind  because  we  identify  our- 
self  with  him  and,  therefore,  in  feeling  for  him  we 
feel  for  ourself .  That  which  is  emphasized  in  sym- 
pathy, therefore,  is  the  suffering  or  distress  of  the 
other  person  which  we  treat  as  if  it  were  our  own. 

The  feeling  of  hate  uses  a  somewhat  different 
mechanism.  Hate  and  all  such  (antipathic)  feelings 
are  reactions  of  the  individual  against  things  which 
threaten  him  (Chap,  III).  Hate  against  certain 
kinds  of  acts  is,  therefore,  not  solely  because  they 
may  be  considered  antisocial,  for  example,  but  be- 
cause as  antisocial  they  are  also  apprehended  as  acts 
which  we  ourselves  might  do,  and  therefore  we  have, 
so  to  speak,  to  array  our  most  powerful  emotional 
weapons  against  them  in  self  defence.  In  the  mech- 
anism which  is  used  by  hate,  therefore,  the  identi- 
fication with  the  other  person,  while  present,  is  by 
no  means  as  obvious.  The  hate  is  directed  more 
towards  his  act  than  towards  himself.  This  is 
clearly  seen  in  those  acts  of  mob  violence  in  which 
an  individual  is  killed  by  a  crowd  of  persons  who 
have  no  knowledge  or  acquaintance  with  him,  for  the 
most  part,  but  are  wreaking  vengeance  upon  him 
because  of  his  act. 

Why  do  we  divide  those  who  are  asocial  or  anti- 
social in  their  behaviour  into  groups  on  the  basis  of 
sympathy  and  hate?  A  complete  answer  to  this 
question  would  have  to  be  an  individual  answer  in 
each  instance.    The  actor  and  the  act  would  not  only 


THE  CRIMINAL  123 

have  to  be  given  consideration  but  the  reactor,  that 
is,  the  person  who  felt  either  sympathy  or  hate,  as 
the  case  might  be,  for  there  are  many  situations  in 
which  some  would  feel  one  and  others  the  other.  In 
general,  however,  it  may  be  said,  as  already  inti- 
mated, that  it  is  only  those  acts  which  come  very 
close  to  what  we  ourselves  wish  to  do  that  we  need 
to  hate. 

This  general  conclusion  is  borne  out  by  the  facts. 
The  thoroughly  strange  behaviour  of  the  insane,  it 
has  been  called  unpsychological  because  it  does  not 
seem  to  be  possible  or  accountable  from  anything 
we  who  are  mentally  well  feel  within  ourselves,  this 
form  of  behaviour  which  seems  to  stamp  the  sick 
person  as  living  in  a  strange  world  quite  different 
from  the  world  we  live  in,  is  relatively  seldom  re- 
sented. Just  because  it  is  so  far  from  seeming  pos- 
sible to  us  we  do  not  have  to  react  against.  Because 
the  insane  person  is  afflicted  with  a  disorder  for 
which  he  seems  to  have  no  responsibility  and,  there- 
fore, about  which  he  can  do  nothing ;  because  his  dis- 
order makes  him  suffer  and  ostracizes  him  from 
society  and  seems  not  to  advantage  hitn  in  any  way ; 
because  of  all  these  things  we  can  have  sympathy 
for  him — feel  for  and  with  him.  Most  of  us  can 
read  or  talk  about  cannibalism  without  being  emo- 
tionally disturbed  just  because  it  is  so  remote  that 
we  do  not  seem  to  be  touched  by  it.  On  the  contrary 
to  come  across  some  one  we  knew  eating  human  flesh 
would  produce  a  most  profound  emotional  revulsion. 

Now  the  criminal  seems  much  more  like  ourselves 


124  MENTAL  HYGIENE 

than  the  insane  person.    He  seems  to  have  acted 
with  those  faculties  with  which  we  are  familiar  in 
ourselves,  and  furthermore  he  has  often  done  those 
things  we  might  be  tempted  to  do.    He  has  acquired 
what  he  desired  by  the  easy  way,  he  has  not  worked, 
laboured,  plodded  for  years,  but  has  just  taken  it 
when  it  came  within  his  grasp.    Our  disinclina- 
tion to  exertion,  our  desire  to  stay  in  the  region  of 
the  known,  the  familiar,  our  dislike  for  the  hard 
facts  and  sharp  corners  of  reality,  in  short  an  in- 
stinctive laziness,  makes  us  all  feel  that  we  would 
like  to  grasp  success  as  easily.    Even  though  we 
might  know  that  real  success  could  never  come  that 
way,  still,  if  we  had  the  opportunity  few  of  us  could 
^resist  it  except  for  the  fact  that  just  these  antipathic 
emotions  come  to  our  aid  and  we  hate  and  despise 
the  man  who  acts  in  that  way  and  correspondingly 
exalt  good  deeds  and  good  men.    How  close  all  such 
activities  lie  to  our  possibilities  of  action  is  seen  on 
the  one  hand  in  the  love  of  the  child  for  tales  of 
pirates  and  highwaymen  and  in  the  ease  with  which 
in  war  times  all  the  social  standards  are  swept  aside 
and  man  yields  to  his  predatory  instincts.     (Note 
the  tales  of  inhumanity,  rape,  pillage,  arson  which 
come  from  fields  of  war.) 

The  conclusion  is  further  supported  by  the  fact 
that  the  tendency  is  constantly  growing  to  get  away 
from  treating  the  insane  like  the  criminal  by  court 
procedure  and  so  forth,  while  if  we  examine  into  the 
method  of  criminal  procedure  we  will  note  that,  so 
far  as  possible,  the  individual  as  such  is  eliminated 


THE  CRIMINAL  125 

and  only  the  act  given  consideration.  Thus  the 
statute  defines  certain  crimes  by  stating  the  act 
which  constitutes  them,  and  in  the  indictment  the 
defendant  is  charged  with  doing  certain  things.  It 
is  the  crime  and  not  the  criminal  that  is  given  first 
consideration. 

We  see  this  emphasized  in  several  directions  when 
we  come  to  consider  some  of  the  results.  A  jury 
will  bring  in  a  verdict  according  to  their  feelings  of 
sympathy  or  hate.  It  is  a  well  known  device  of  the 
defence  to  give  the  jury  an  excuse  for  declaring  the 
prisoner  *'not  guilty"  if  it  is  felt  that  they  would 
wish  to.  An  occasional  excuse  is  that  of ' '  insanity. ' ' 
I  have  known  trials  in  which  there  was  never  any 
question  but  that  the  defendant  had  done  the  act 
charged,  in  which  a  defence  of  insanity  was  entered 
and  almost  no  evidence  introduced  to  support  it  and 
that  of  the  flimsiest  kind.  Nevertheless  the  jury 
found  the  defendant  insane  because,  in  my  belief, 
they  felt  unconsciously  they  would  have  wanted  to 
do  just  what  he  did,  under  like  circumstances. 
Juries,  too,  sometimes  bring  in  a  compromise  ver- 
dict which  has  no  possible  logical  sense.  For  in- 
stance, a  person  is  charged  with  murder  in  the  first 
degree.  He  is  clearly  either  guilty  and  should  be 
hung  under  the  law  or  he  is  insane  and  so  innocent. 
The  jury  find  a  verdict  of  murder  in  the  second  de- 
gree. Such  a  verdict  can  only  be  explained  as  a 
compromise  of  sympathy  and  hate  in  the  jury  and 
in  no  other  way.  Such  cases,  and  there  are  many  of 
them,  still  further  illustrate  my  conclusion. 


126  MENTAL  HYGIENE 

If  we  examine  further  the  methods  of  criminal 
procedure  we  will  find  further  evidence  of  the  same 
Mnd.  As  I  have  indicated,  the  whole  procedure 
tends  to  consider  the  act  rather  than  the  actor.  The 
medical  expert,  for  example,  is  asked  a  hypothetical 
question  in  which  a  certain  group  of  facts  or  alleged 
facts  taken  from  the  evidence  are  attached  to  a 
hypothetical  individuality  and  his  opinion  is  asked 
as  to  the  sanity  or  responsibility  of  this  hypothetical 
person.  The  theory  is  that  only  the  jury  can  deal 
with  the  question  of  the  sanity  or  responsibility  of 
the  defendant,  that  is  a  question  of  fact  and  the 
ultimate  one  for  them  to  decide,  but  in  reaching  a 
decision  the  defendant  as  such  is  kept  in  the  back- 
ground as  much  as  possible  and  the  act,  constituting 
the  crime,  is  given  the  principal  consideration. 
This,  of  course,  tends  to  give  the  hate  motivated  ac- 
tivities free  play  because  they  are  not  directed  to 
any  person.  The  expert,  for  example,  passes  upon 
the  sanity  of  a  hypothetical  individual  in  a  presum- 
ably wholly  judicial  frame  of  mind  and  free  from 
any  consideration  of  humanity  or  sympathy  which 
might  make  him  hesitate  if  he  were  actually  asked 
to  do  an  act  which  would  send  a  man  to  his  death. 
The  method  of  procedure  is  the  method  of  indirec- 
tion. 

•  To  sum  up  the  whole  matter,  the  jury  listens  to  the 
evidence  and  then  gives  a  verdict  which  is  very  apt 
to  be  much  more  controlled  by  their  unconscious 
than  by  their  clear  consciousness,  and  the  degree  to 
which  the  unconscious  controls  is  based  upon  the 


THE  CRIMINAL  127 

closeness  of  the  particular  situation  to  the  particular 
jury  in  their  feelings  and  their  necessity  of  defence 
from  such  a  realization.  Of  course  it  is  idle  to  ex- 
pect any  results  from  such  a  system  which  square 
■with  an  at  all  exalted  ideal  of  justice.  It  is  only  a 
bit  of  machinery  for  transmitting  the  herd  critique. 

That  this  is  the  mechanism  is  further  illustrated 
by  the  way  in  which  the  result  is  explained.  A 
given  defendant  is  decided  to  be  guilty  because  in 
the  opinion  of  the  jury  he  was  responsible  for  the 
act  with  which  he  was  charged.  This  concept  of 
responsibility  comes  about  as  an  explanation  for  the 
action  which  it  is  desired  to  take.  It  is  not  some- 
thing, as  ordinarily  supposed,  which  exists  in  the 
criminal  like  a  familiar  spirit,  but  is  something  pro- 
jected upon  him  by  the  herd,  that  is,  by  the  herd  in 
miniature,  the  jury.  This  is  the  mechanism  of  ra- 
tionalization or  the  making  of  something  to  appear 
reasonable  which  really  had  its  inception  and  motive 
in  the  unconscious,  in  the  feelings  and  instincts 
rather  than  the  reason  and  judgment. 

The  attempt  to  deal  with  acts  and  not  the  actors, 
to  deal  with  crime  rather  than  the  criminal  gives  rise 
to  that  sort  of  maladjustment  which  always  results 
from  trying  to  press  a  living,  moving,  growing  dy- 
namic impulse  into  a  rigid,  static  form,  to  press  the 
problem  of  human  life  into  a  statutory  definition. 
A  general  principle,  such  as  that  embodied  in  a  stat- 
ute, and  intended  to  apply  to  all  cases,  by  that  same 
token,  applies  to  none;  what  is  made  to  include  all 
cannot,  of  necessity,  exactly  fit  any  particular  case ; 


128  MENTAL  HYGIENE 

the  abstract  proposition  never  quite  describes  the 
concrete  case. 

Human  beings,  individually  and  collectively,  are 
always  trying  to  get  things  settled,  to  express  them- 
selves in  a  final  formulation  about  things,  to  com- 
pass a  problem  completely  in  a  definition  or  a  law, 
but  reality  always  just  escapes,  they  never  can  quite 
do  it.  They  are  doomed  to  find  as  a  result  of  each 
effort  only  one  more  way  in  which  it  just  cannot  be 
done.  To  be  able  to  fix  reality  in  some  final  formu- 
lation would  be  to  secure  for  all  time  certainty  where 
now  there  is  uncertainty,  the  known  where  now  there 
is  the  unknown.  It  is  the  everlasting  search  for  the 
fixed  and  the  stable  in  a  world  which  in  its  very 
essence  is  dynamic.  It  is  our  old  friend  again,  the 
instinct  for  the  familiar — the  safety  motive. 

Trial  and  failure,  however,  are  the  very  essence 
out  of  which  progress  is  made.  A  given  formula- 
tion solves  one  problem  and  opens  up  an  hundred 
more,  but  then  these  hundred  represent  the  new 
light  that  has  been  shed  by  the  solution  and  the 
whole  matter  is  attacked  from  a  higher  plane,  a 
new  level  of  integration  has  been  attained.  And  so 
each  formulation  stimulates  to  new  inquiries,  which, 
when  pretty  well  worked  over  give  birth  to  another 
formulation  to  take  the  place  of  the  last  one,  and  so 
on. 

The  law  can  only  embody  those  principles  of  con- 
duct which  are  acceptable  to  the  community  and 
therefore  cannot  be  materially  at  a  higher  point  in 
the  integration  scale  than  that  community.    Nat- 


THE  CRIMINAL  129 

Tirally,  therefore,  it  must  necessarily  appear  primi- 
tive and  unjust  to  special  students.  The  jury,  as 
we  have  seen,  representing  society  in  miniature, 
brings  in  its  verdict  in  accordance  with  its  uncon- 
scious vibrating  in  harmony  with  the  unconscious 
of  the  herd  out  of  which  grew  the  law.  The  integra- 
tion has  to  be  pushed  upward  from  this  level,  there- 
fore, and  no  effort  which  seeks  to  impose  law  upon 
a  community  otherwise  can  expect  to  succeed.  Sta- 
bility of  government  is  grounded,  in  the  last  analy- 
sis, in  the  consent  of  the  governed  only  both  the 
forms  and  institutes  of  the  government  and  the  con- 
sent of  the  governed  are  much  more  products  of 
the  unconscious  than  is  generally  appreciated. 

THE   RESULTS 

The  results  of  treating  men  in  accordance  with 
the  principles  as  I  have  explained  them  have  been 
known  by  prison  reformers  for  a  long  time.  They 
can,  of  course,  not  be  otherwise  than  destructive  as 
are  all  lines  of  conduct  which  derive  their  strength 
from  hate.  The  prison  system  is  a  means  of  pun- 
ishment both  negative  and  positive.  It  punishes 
in  a  negative  way  by  taking  out  of  life  everything 
desirable  and  positively  by  enforcing  all  sorts  of  re- 
pressive measures.  Repression  is  the  order  of  the 
day.  The  prisoner  cannot  talk,  he  cannot  turn  his 
head  at  mealtime,  he  cannot  go  to  his  cell  except  at 
certain  times  nor  leave  it  except  at  certain  times, 
he  cannot  walk  except  in  a  certain  way,  and  so  forth 
and  so  on,  a  series  of  negations,  of  prohibitions. 


130  MENTAL  HYGIENE 

Now,  while  such  a  scheme  of  living  would  take  all 
the  joy  out  of  life  for  most  any  one  it  would  also  be 
impossible  to  endure  by  very  many.  It  takes  a 
fairly  good  character  make-up  to  be  able  to  stand  a 
long  period  of  such  systematic  repression  with 
hardly  an  avenue  open  for  wholesome  self-expres- 
sion in  any  direction.  And  when  we  remember  that 
many  who  find  their  way  to  prison  must  necessa- 
rily, because  they  exhibit  a  socially  inadequate  adap- 
tation, be  of  defective  type  of  personality,  we  can 
still  further  understand  how  the  prison  regime 
serves  to  ''break"  the  prisoner.  The  multitude  of 
prison  rules,  not  being  formulated  to  help  the  pris- 
oner but  to  keep  a  dangerous  population  safely  sub- 
dued, operate  to  destroy  both  mind  and  body  so 
that  society,  through  its  prison  system,  has  been 
wreaking  an  awful  revenge  upon  those  who  do  not 
conform  by  ruining  them  mentally  and  physically, 
destroying  them  body  and  soul.  Society  tries  to 
rid  itself  of  its  antisocial  parasitic  growths  some- 
what as  the  surgeon  tries  to  remove  a  cancerous 
growth  from  the  body.  Except  in  the  case  of  cap- 
ital punishment,  however,  the  method  is  less  heroic 
and  reminds  us  more  of  the  old  days  of  treating 
cancer  with  arsenic  paste.^ 

This  breaking  of  men  by  severity  of  punishment 
is  a  very  costly  operation.    In  the  first  place  the 

2  The  application  of  a  corrosive  paste  containing  arsenic  which 
slowly  burned  the  cancer  away  and  incidentally  any  of  the  sur- 
rounding flesh  with  which  it  came  in  contact.  Clumsy,  inexact, 
painful,  impossible  of  control,  often  ineffectual  and  injurious  to  sur- 
rounding healthy  tissues. 


THE  CRIMINAL  131 

history  of  punishment  shows  pretty  clearly  that 
severity  of  punishment,  on  the  whole,  has  had  little 
influence  on  the  prevention  of  crime;  to  suppose 
that  it  has  is  to  fail  to  understand  at  all  the  crim- 
inal's psychology,  to  see  him  as  a  social  maladapta- 
tion  acting  upon  impulse  uncontrolled  by  reason, 
but  rather  to  attribute  to  him  the  attitude  and  rea- 
soning faculties  of  a  normal  individual  free  from 
emotional  stress  as  he  discusses  in  his  study  the 
relative  advantages  and  disadvantages  of  a  crim- 
inal career.  It  does  not  do  the  individual  any  good, 
quite  the  contrary  it  injures  him  in  every  way,  and 
finally  it  does  not  do  society  any  good  because  it 
insures  the  continued  failure  of  the  criminal  after 
his  discharge  from  prison  with  all  that  that  means, 
not  only  in  expense  but  in  efficiency,  rather  than 
helping  him  to  become  a  useful  citizen.  The  hate 
which  society  expends  upon  the  criminal  is  returned 
by  the  criminal  in  his  hate  for  society — a  mutually 
destructive  process  in  which  it  is  hard  to  see  how 
any  gain  can  be  registered. 

THE  CEIMINAL  AS  SCAPEGOAT 

If  we  gather  together  all  of  those  things  which  I 
have  indicated  as  explaining  the  nature  of  criminal 
conduct,  and  bear  in  mind  the  principle  which  has 
been  set  forth  to  explain  the  need  and  the  value  of 
the  antipathic  emotions,  and  look  for  a  recognized 
principle  of  human  conduct  underlying  it  all,  we 
will  find  it  in  the  concept  of  the  scapegoat.^ 

3  The  reader  is,  by  all  means,  advised,  in  this  connection,  to  read 


132  MENTAL  HYGIENE 

The  obvious  principle  embodied  in  the  concept  of 
the  scapegoat  was  the  principle  that  evil  could  be 
gotten  rid  of  by  transferring  it  to  some  object, 
animal,  or  even  man  and  then  by  getting  rid  of  them 
the  evil,  of  course,  went  along.  It  is  the  principle 
otherwise  known  as  the  principle  of  vicarious  suf- 
fering. As  Frazer  very  well  puts  it,  namely,  that 
because  he  can  shift  a  burden  of  wood  or  stones 
from  his  back  to  that  of  another  the  savage  imagines 
that  he  can  as  easily  shift  his  burden  of  pain  and 
sorrow  to  another  who  will  bear  it  in  his  stead.  A 
few  examples  make  the  principle  clear.*  In  some 
of  the  East  Indian  islands  epilepsy  is  believed  to  be 
cured  by  striking  the  patient  on  the  face  with  the 
leaves  of  certain  trees  and  then  throwing  the  leaves 
away.  The  disease,  transferred  to  the  leaves  by 
this  process,  disappears  with  them.  In  certain  of 
the  tribes  of  Central  Australia  the  men,  when  suffer- 
ing from  headache,  would  wear  women's  head  rings 
in  the  belief  that  the  pain  would  pass  into  the  rings 
and  could  then  be  gotten  rid  of  by  throwing  them 
into  the  bush.  These  are  perfectly  typical  exam- 
ples of  this  kind  of  conduct.  To  show  in  what  a 
concrete  way  pain  is  conceived  of  the  example  of 
the  Australian  blacks'  way  of  dealing  with  tooth- 
ache is  illuminating.  A  heated  spear-thrower  is 
held  to  the  cheek  and  then  cast  away.  The  tooth- 
ache goes  with  it  in  the  shape  of  a  black  stone  called 

"The  Scapegoat,"  which  is  Pt.  VI  of  "The  Golden  Bough,  A  Study 
in  Magic  and  Religion,"  by  J.  G.  Frazer.     Published  by  Macmillan  & 
Co.,  London. 
4  All  examples  are  from  Frazer,  1.  c. 


THE  CRIMINAL  133 

Tcarriitch.  Stones  of  this  kind  are  found  in  old 
mounds  and  sand  hills  and  are  carefully  collected 
and  used  to  throw  in  the  direction  of  enemies  in  or- 
der to  give  them  the  toothache. 

In  a  precisely  similar  way  evil  is  transferred 
to  animals.  Among  the  Malays  if  a  wild  bird  flies 
into  the  house  it  is  caught,  smeared  with  oil,  then 
released,  a  formula  being  recited  in  which  it  is  bid- 
den to  fly  away  with  all  the  ill-luck  and  misfortunes 
of  the  occupant.  In  Arabia,  when  the  plague  is  rag- 
ing, a  camel  is  led  through  all  the  quarters  of  the 
town  in  order  that  it  may  take  the  pestilence  on  it- 
self. The  camel  is  then  killed.  After  an  illness  a 
Bechuana  king  seated  himself  upon  an  ox.  The 
native  doctor  poured  water  over  the  king  which  ran 
down  over  his  body.  The  ox  was  then  killed  by 
holding  his  head  in  a  vessel  of  water  until  it  ex- 
pired. The  people  believed  that  the  ox  died  of  the 
king's  disease  which  had  been  thus  transferred  to  it. 

The  transfer  may  be  effected  to  human  scapegoats 
in  similar  manner.  For  example,  the  sins  of  the 
Eajah  of  Manipur  and  his  wife  could  be  transferred 
to  some  one  else,  usually  a  criminal,  who  earned 
his  pardon  by  his  vicarious  sufferings.  This  was 
done  by  the  royal  couple  bathing  on  a  scaffold  be- 
neath which  the  criminal  crouched.  The  water 
washed  their  sins  away  and  falling  upon  the  human 
scapegoat  transferred  their  sins  to  him.  In  Uganda 
when  the  king  had  been  warned  by  the  gods  that 
evil  attached  to  his  army  it  was  customary  to  pick 
out  a  woman  slave  from  among  the  captives,  a  cow, 


134  MENTAL  HYGIENE 

a  goat,  a  fowl,  and  a  dog.  Bunches  of  grass  were 
rubbed  over  the  people  and  cattle  to  collect  the  evil 
and  transfer  it  to  the  victims  who  were  then  taken 
a  considerable  distance  and  their  limbs  broken,  so 
they  could  not  crawl  back  to  Uganda,  and  left  to 
die. 

From  using  a  scapegoat  upon  occasions  and  for 
such  purposes  as  I  have  indicated  it  comes  to  be 
resorted  to  periodically,  usually  annually.  Such 
periodic  use  of  a  scapegoat  also  implies  that  the 
scapegoat  is  a  public  one,  that  is,  at  certain  sea- 
sons of  the  year  the  people  rid  themselves  of  their 
sins  by  a  public  scapegoat.  On  the  Day  of  Atone- 
ment the  Jewish  high-priest  laid  his  hands  on  the 
head  of  a  goat,  confessed  all  the  iniquities  of  the 
Children  of  Israel,  and  having  thus  transferred 
their  sins  to  the  animal,  drove  it  into  the  wilder- 
ness. At  Onitsha,  on  the  Niger,  two  human  beings 
are  annually  purchased  by  public  subscription  and 
sacrificed  to  take  away  the  sins  of  the  land.  All 
those  who  during  the  year  had  been  grossly  sin- 
ful were  expected  to  contribute,  and  the  money  so 
collected  was  used  to  purchase  two  sickly  persons 
who  were  offered  as  sacrifices,  one  for  the  land  and 
one  for  the  river. 

This  last  example  is  interesting  as  showing  the 
tendency  to  select  people  who  had  to  die  anyway 
(in  this  case  of  disease)  for  sacrificial  victims.  It 
therefore  is  not  strange  to  find  a  tendency,  prob- 
ably going  along  with  a  developing  lack  of  sym- 
pathy with  human  sacrifices,  to  sacrifice  those  al- 


THE  CRIMINAL  135 

ready  condemned  to  death  or  convicted  of  crime  as 
being  those  with  whom  there  would  be  little  or  no 
sympathy.  So  in  the  case  of  the  Eajah  of  Manipur 
it  was  a  criminal  who  was  selected  to  bear  his  sins. 
Similarly  the  Ehodians  annually  sacrificed  a  crim- 
inal to  Cronus.  They  kept  him  in  prison  until  the 
festival  of  Cronia  when  they  led  him  outside  the 
gates,  made  him  drunk  and  cut  his  throat.  This 
custom  appears  too  to  have  been  substituted  for 
an  earlier  sacrifice  of  an  innocent  victim.  A  crim- 
inal was  also  sacrificed  at  Babylon  at  the  festival 
of  the  Sacaea. 

The  principle  which  runs  through  all  these  cus- 
toms is  clear  and  seems  to  be  a  universal  charac- 
teristic of  man.  Man  is  always  trying  to  get  rid 
of  what  makes  him  unhappy  and  if  this  is  sin,  that 
is,  is  wrong  in  the  sense  of  the  mores  ^  (the  ethical 
standards  of  the  herd),  he  tries  also  to  escape  re- 
sponsibility for  it.  In  punishing  the  criminal, 
therefore,  he  is  not  trying,  primarily,  to  get  rid  of 
sin  in  the  abstract,  that  is  a  rationalization  of  his 
conduct,  he  is  trying  to  get  rid  of  that  sin  which  he 
feels  is  resident  within  himself.  The  criminal  then 
becomes  a  handy  object  upon  which  he  can  transfer 
his  sin  and  thus  by  punishing  the  criminal  he  de- 
ludes himself  into  a  feeling  of  righteous  indignation, 
thus  bolstering  up  his  own  self-respect  and  serving, 
in  this  roundabout  way,  to  both  restrain  himself 

5W.  G.  Sumner:  "Folkways,  A  Study  of  the  Sociological  Im- 
portance of  Usages,  Manners,  Customs,  Mores,  and  Morals."  Ginn  & 
Co.,  Boston,  1907, 


136  MENTAL  HYGIENE 

from  like  indulgences  and  to  keep  himself  upon  the 
straight  and  narrow  path. 

This  is  the  material  out  of  which  is  made  our  un- 
conscious attitude  toward  crime  and  criminals  and 
is  an  explanation  of  why  society  has  been  so  loathe 
to  admit  reforms  in  dealing  with  the  criminal,  and 
also  why  it  has  been  willing  to  permit  the  grievous 
abuses  to  which  he  has  been  subjected. 

THE  KEMEDY 

To  treat  the  criminal  by  the  scheme  of  punishment 
that  has  been  in  vogue  so  long,  which,  in  fact,  is  in 
principle  the  principle  of  the  Mosaic  law  ''an  eye 
for  an  eye,  and  a  tooth  for  a  tooth"  can  no  longer 
be  justified.  While  at  one  time  in  the  history  of 
mankiad  such  methods  were  not  only  justifiable  but 
embodied  the  only  possible  solution  of  the  difficul- 
ties, that  can  no  longer  be  held  in  this  scientific  day 
and  age.  It  is  time  that  the  spirit  of  revenge  should 
be  put  aside  for  a  more  constructive  program 
than  has  thus  far  been  made  possible  by  the  more 
and  more  impersonal  attitude  of  the  criminal  fos- 
tered by  the  methods  of  crimiaal  procedure  already, 
in  part,  alluded  to.  Not  only  does  the  law  consider 
the  crime  rather  than  the  criminal,  but  in  the  carry- 
ing out  of  retributive  acts  the  individual  has  handed 
over  the  conduct  of  his  personal  quarrels  to  a  spe- 
cial group  of  men  selected  for  that  particular  pur- 
pose. He  has  delegated,  so  to  speak,  the  wreaking 
of  his  personal  revenges  to  the  officers  of  the  law. 

Eealizing  the  meaning  of  these  various  mechan- 


THE  CRIMINAL  137 

isms  we  can  understand  somewhat  why  the  criminal 
law  is  so  slow  to  change.  Mankind  gives  up  with 
great  reluctance  the  small  measure  of  revenge  which 
this  scheme  leaves  to  them,  and  perhaps  it  may  be 
just  as  well  if  we  can  find  some  other  way  to  at- 
tack the  problem  in  an  at  all  satisfactory  way.  This 
has  already  been  done  by  taking  up  the  problem 
from  an  angle  bound  to  appeal  to  the  sympathy  of 
every  one,  namely,  in  connection  with  the  work  of 
the  juvenile  courts.  The  next  avenue  of  approach 
is  of  course  the  criminal  himself  after  conviction. 
After-care  societies  that  attempted  to  get  the  dis- 
charged criminal  a  place  and  so  help  him  to  re-es- 
tablish himself  have  existed  for  a  long  time.  The 
destructive  work  of  the  prison,  however,  was  so 
well  done  that  they  have  obtained  but  indifferent 
success.    The  work  must  begin  earlier. 

To  be  of  real  value,  then,  the  work  must  be  be- 
gun in  prison.  Society  will  have  used  the  prisoner 
as  its  scapegoat,  condemned  him  to  punishment, 
and  having  shut  him  up  in  prison  is  pretty  willing 
to  forget  a  disagreeable  matter  and  so  leave  him  to 
those  who  are  charged  with  his  care.  It  is  with 
these  caretakers,  therefore,  that  the  immediate  hope 
for  the  work  of  prison  reform  rests.  So  long  as 
they  conduct  their  work  in  a  way  not  to  stir  up  an- 
tagonism they  will  probably  be  permitted  to  go  on 
with  it.  The  principles  of  the  work  are  relatively 
simple. 

The  defect  in  the  criminal  is  that,  for  some  reason 
or  other,  he  has  been  unable  to  adjust  his  conduct 


138  MENTAL  HYGIENE 

to  socially  acceptable  standards.  This  incapacity 
may  be  deeply  organic  (severe  grades  of  mental 
defect)  and  therefore  incapable  of  remedy,  or  it 
may  be,  and  often  is,  due  to  faults  of  environment 
and  education.  One  could  hardly  expect  a  child 
brought  up  in  the  criminal  quarter  of  a  large  city 
and  surrounded  on  all  sides  by  crime,  perhaps 
taught  criminal  practices  in  his  early  childhood,  to 
grow  into  anything  but  a  criminal.  Such  a  child 
is  reacting  in  precisely  the  same  way  as  his  more 
fortunately  situated  brothers — ^he  is  simulating  his 
elders.  Many  such  criminals  are  fundamentally 
well  endowed  but  owing  to  the  accident  of  their 
birth,  so  to  speak,  have  never  really  had  a  chance. 
They  have  remained  at  a  relatively  low  cultural 
level  of  development  because  their  immediate  en- 
vironment never  demanded  anything  more  of  them. 
They  were  adjusted  to  the  environment  in  which 
they  found  themselves.  Such  an  individual,  when 
imprisoned,  offers  the  best  material  to  work  with 
and  a  fair  prospect  of  good  results. 

For  such  a  type  the  unintelligent  and  revengeful 
attitude  of  the  usual  prison  environment  can  do 
nothing  but  further  debase  not  only  mentally  but 
physically.  Instinctive  tendencies,  fundamental  bio- 
logical trends  when  not  permitted  a  normal  and 
natural  outlet  must  find  some  other  path  and  so 
necessarily  give  origin  to  conduct  that  is  patho- 
logical. Such  conduct,  still  further  repressed  by 
the  prison  authorities,  aggravates  the  pathological 
tendencies  and,  as  a  consequence,  the  not  at  all 


THE  CRIMINAL  139 

surprising  result  is  all  too  frequent,  a  psychosis. 
Taken  from  a  pathological  environment  in  the  first 
instance  he  is  thrust  into  a  far  more  pathological 
one  and  as  a  result  is  expected  to  get  weU,  that  is, 
learn  better,  go  out  upon  his  discharge  resolved  to 
lead  a  normal  life.  The  good  people  who  devised 
the  system  of  solitary  confinement,  for  so  long  in 
operation  in  Pennsylvania,  thought  solitude  conduc- 
ive to  reflection  and  that  the  prisoner,  left  to  his 
own  thoughts,  would  dwell  upon  his  sinfulness  and 
so  come  into  a  state  of  righteousness.  To  effect 
this  the  prisoner  was  locked  in  his  single  cell  and 
never  during  the  term  of  his  Imprisonment,  no  mat- 
ter how  many  years,  saw  or  spoke  to  a  single  human 
being  except  his  gaoler  or  perhaps  the  chaplain.  If 
he  was  to  be  moved  to  another  part  of  the  prison 
a  cap  was  drawn  over  his  head  and  face  so  he  could 
see  no  one.  The  results  of  such  treatment  may  be 
imagined.  Man  is  a  social  animal,  psychological 
reactions  are  made  up  in  large  part  of  reactions  at 
the  social  level,  he  cannot  be  torn  from  his  associates 
and  placed  in  solitude  and  continue  to  live  normally 
mentally  or  any  other  way.  These  prisoners,  in 
large  numbers,  developed  psychoses  and  I  have  been 
informed,  if  discharged  after  a  long  time,  could  be 
seen  after  stepping  through  the  door  to  wander 
aimlessly  and  helplessly  about  the  prison  wall  quite 
unable  to  face  the  outside  world  of  reality,  crushed, 
broken  in  spirit,  in  mind,  and  in  body.  Such  horrid 
things  are  hardly  less  harmful  to  those  who  inflict 
them  than  to  those  who  suffer  them.     Society  can 


140  MENTAL  HYGIENE 

no  longer  afford  to  crush  its  creatures  in  this  way. 

Instead  of  thrusting  the  offender  into  a  patho- 
logical environment,  worse  than  the  one  he  was 
taken  from,  the  environment  should  be  calculated 
to  develop  all  that  is  best  in  the  prisoner.  The 
object  of  the  prison  is  nominally,  and  should  be  so 
in  fact,  to  rehabilitate  the  prisoner  and  fit  him  for 
a  useful  social  life.  If  it  is  going  to  be  able  to  make 
over  an  antisocial  individual  into  a  useful  citizen 
it  must  undertake  to  do  so  by  attempting  to  de- 
velop those  qualities  in  him  which  make  for  good 
citizenship.  It  goes  without  saying  that  a  pro- 
gram of  repression  that  is  only  repression  will 
not  only  not  do  this  but  is  wholly  incapable  of  de- 
veloping anything  that  is  constructive,  it  only  drives 
the  prisoner  to  pathological  ways  of  expression. 
The  direction  in  which  to  proceed  is  to  endeavour 
to  produce  conditions  within  the  prison  as  nearly 
as  possible  like  those  outside  more  especially  as  to 
the  matter  of  personal  responsibihty.  In  other 
words,  the  prison  must  try  to  develop  in  the  prisoner 
those  qualities  of  personal  and  social  responsibility 
which  are  necessary  for  him  to  have  if  he  is  to  be 
able  to  live  a  useful  life  in  the  community. 

This  effort  to  develop  the  capacity  for  adequate 
social  adjustments  in  the  prison,  is  the  basic  prin- 
ciple upon  which  the  Mutual  Welfare  League  was 
founded  by  Mr.  Osborne  ^  at  Sing  Sing  prison.  His 
experiment  corrected  the  fault  of  previous  efforts  of 

6  T.  M.  Osborne :   "Society  and  Prisons."     Yale  University  Press, 
Kew  York,  1916. 


THE  CRIMINAL  141 

like  kind  in  which  the  same  sort  of  experiment  had 
been  carried  out  in  form  but  not  in  substance.  In 
order  to  accomplish  its  purpose,  he  thinks,  the 
prisoners  must  actually  be  permitted  to  establish 
their  own  scheme  of  government  and  to  carry  it  out 
with  practically  no  interference  from  the  warden's 
office.  Only  under  these  circumstances,  where  au- 
thority and  responsibility  are  commensurate,  can 
there  be  borne  home  to  the  soul  of  the  prisoner  those 
distinctions  between  right  and  wrong  upon  which 
the  orderly  conduct  of  society  is  founded. 

It  was  Socrates  who  said  that  knowledge  was 
virtue,  and  I  think  Mr.  Osborne  would  agree  with 
him  in  such  a  statement,  except  that  it  is  plain 
that  it  makes  a  great  deal  of  difference  what  is 
meant  by  knowledge.  The  lecturing  of  a  convicted 
criminal  by  the  judge  who  exhibits  anger  and  re- 
sentment and  hate  in  his  denunciation  of  the  poor 
wretch  whom  he  is  about  to  sentence  to  prison  may 
convince  the  prisoner  intellectually  or  may  only 
reiterate  what  he  already  knows.  The  beatings,  the 
deprivations  of  food,  the  dark  cell  may  do  the  same 
thing  in  prison,  but  knowledge  acquired  in  such 
ways,  if  indeed  it  can  be  called  knowledge  at  all,  is 
of  no  value.  Knowledge  is  virtue  but  it  is  only 
virtue  when  we  have  learned  to  know  in  the  same 
way  that  we  love.  To  know  as  one  loves  is  not 
only  to  appreciate  intellectually,  but  to  feel  the  fun- 
damental truth  in  a  way  that  makes  it  essential  to 
act  upon  it. 

The  lecturing  of  a  prisoner  by  the  presiding  judge 


142  MENTAL  HYGIENE 

is  a  part  of  just  one  item  in  the  almost  universal 
unintelligence  which  the  great  man-hunting  machin- 
ery of  the  criminal  law  exhibits.  It  is  as  if  a  per- 
son had  become  ill  from  a  long  course  of  wrong 
living,  extending  over  years,  and  the  doctor  should 
dismiss  him  with  a  prescription  for  a  pill  and  say 
not  a  word  about  the  regulation  of  his  life.  The 
criminal  act  which  finally  leads  to  a  prison  sentence 
is  but  the  outcome  of  a  life  of  distorted  viewpoints, 
of  standards  of  conduct  turned  and  twisted  out  of 
all  resemblance  to  those  with  which  the  normal  per- 
son is  familiar  in  his  daily  living,  and  to  expect  that 
the  natural  product  of  such  conditions  can  be 
metamorphosed  by  a  three  miaute  sermon  displays 
a  profound  ignorance  of  human  beiags.  A  prisoner 
so  lectured  will  probably  leave  the  court  room  to 
start  upon  the  serving  of  his  sentence,  not  in  a  hum- 
ble frame  of  mind  resolved  to  make  out  of  his  mis- 
fortune an  opportunity  for  development,  he  does  not 
know  anything  about  such  things,  he  has  never 
thought  such  thoughts,  never  been  able  to,  never 
developed  enough  to  entertain  them.  He  is,  how- 
ever, accustomed  to  hate  and  act  from  the  spirit 
of  revenge  and  so  he  will  probably  react  to  such  a 
lecture  in  about  the  only  way  he  knows  how  to  re- 
act— ^with  hate  and  enmity.  He  will  leave  the  court 
in  hate  and  start  his  sentence  in  hate,  and  it  will  re- 
main for  the  prison  to  undo  this  damage  and  teach 
him  that  knowledge  is  virtue,  not  by  precept  or  even 
by  example,  but  by  giving  him  an  opportunity  to 


THE  CRIMINAL  143 

live  so  that  the  experiences  of  his  living  will  bear 
this  truth  in  to  him. 

The  concrete,  specific  ways  in  which  this  is  at- 
tempted are  few  and  simple  in  principle.  In  the 
first  place  he  must  be  sufficiently  educated  to  give 
him  a  chance.  A  man,  nowadays,  who  can  neither 
read  nor  write  is  so  handicapped  that  he  is  almost 
forced  to  steal  to  live  so  poor  are  the  returns  from 
plain,  unskilled  labour.  Secondly  he  must  be 
taught  some  kind  of  work  that  he  can  do,  not  only 
in  prison,  but  work  that  will  fit  him  for  earning  a 
good  living  after  his  discharge.  Of  course,  mean- 
time he  should  have  a  chance  to  keep  physically  well 
or  if  he  is  not  well  to  get  well.  It  seems  obvious, 
without  further  discussion,  that  to  keep  a  prisoner 
in  unsanitary  and  unhygienic  surroundings  and  thus 
break  his  health  is  a  poor  investment  for  the  State 
aside  from  any  consideration  for  the  prisoner  him- 
self. And  finally  he  should  be  given  an  opportunity 
at  that  sort  of  self  government  which  makes  for  the 
development  of  personal  responsibility. 

A  considerable  proportion  of  the  prison  popula- 
tion are,  however,  not  normal  in  their  developmental 
possibilities.  Upwards  of  fifty  per  cent,  as  they 
are  admitted  have  demonstrable  disease  at  the  cen- 
tral nervous  system  level.  That  is,  they  are  men- 
tally defective,  psychotic,  or  have  gross  central 
nervous  system  disease  such  as  arteriosclerosis  or 
syphilis.  This  does  not  include  bodily  diseases 
other  than  that   of  the   central  nervous    system. 


144  MENTAL  HYGIENE 

Quite  a  few  prisoners  on  admission  are  physically 
ill.  Acute  venereal  infections  and  tuberculosis  are 
considerably  in  evidence.  The  prison  should  sort 
out  all  these  various  classes  immediately  upon  ad- 
mission and  treat  them  accordingly  and  not,  as  has 
been  the  custom  in  the  past,  try  to  fit  them  all  into 
the  same  form,  treat  them  all  just  alike.  Those 
who  are  physically  sick  need  treatment.  On  the 
medical  side  the  principle  is  the  same  as  with  the 
insane  and  the  feeble  minded,  namely  to  train  the 
individual  to  live  at  his  best  at  the  level  of  adjust- 
ment which  he  is  capable  of  maintaining.  Such 
a  constructive  program  develops  the  best  that  is 
in  the  individual  and  is  equally  advantageous  for 
society  because  it  raises  the  efficiency  of  a  social 
unit. 

The  details  of  such  a  plan  as  I  have  outlined  I 
will  not  enter  into  here  as  I  am  only  dealing,  in  this 
book,  with  the  principles  of  mental  hygiene.  I  can- 
not refrain,  however,  from  touching  upon  one  mat- 
ter that  strikes  me  as  important  and  as  indicating 
a  pathway  which  might  be  followed  to  great  ad- 
vantage. One  of  the  principal  difficulties  which  has 
always  confronted  the  problem  of  prison  labour  and 
prison-made  materials  has  been  the  opposition  of 
the  labour  unions.  I  do  not  know  just  how  this 
antagonism  is  going  to  work  out  but  I  am  convinced 
that  it  will  ultimately  be  adjusted  to  the  satisfac- 
tion of  labour  when  labour  sees  that  co-operation 
and  not  antagonism  is  to  its  advantage.  I  am  con- 
vinced that,  with  modern  machinery  and  shop  meth- 


THE  CRIMINAL  145 

ods  of  management,  the  prisons  could  be  made 
largely  self-supporting  with  material  reduction  in 
the  tax  rates  as  a  consequence.  Besides  I  am  sure 
that  the  able  bodied  prisoners  could  manufacture 
and  raise  on  farms  a  very  large  part  of  the  material 
needed  by  the  sick  and  infirm  in  other  public  insti- 
tutions and  in  many  other  public  projects  could  find 
ample  room  for  activity  when  the  public  mind  gets 
adjusted.  For  example,  the  prisoners  might  make 
material  for  the  army  and  navy,  a  suggestion  which 
might  not  be  well  received  as  yet,  for  I  recently  saw 
that  prison  made  goods  had  been  rejected  by  an 
army  officer  because  the  soldiers  might  have  some 
sentiment  against  wearing  it.  If  the  soldiers  ap- 
preciated that  the  making  of  what  they  wore  had 
helped  save  a  fellow  being  from  destruction  I  am 
sure  they  would  not  object. 

Not  only  this  but  the  scheme  of  teaching  prisoners 
to  work  efficiently  at  some  trade  and  then  utilizing 
the  products  of  their  work  is  a  scheme  which  could, 
to  advantage,  be  applied  to  a  large  part  of  the  rela- 
tively unproductive  and  destructive  elements  in  the 
community.  It  is  applied  here  and  there  but  the 
administrative  divisions  of  State  government  are 
usually  not  sufficiently  well  co-ordinated  to  develop 
such  a  scheme  to  its  maximum  of  efficiency. 

"With  our  modern  methods  it  would  be  a  relatively 
simple  thing  to  devise  and  to  construct  a  plant,  a 
series  of  plants,  which  could  turn  out  a  pair  of  shoes 
for  every  individual  in  the  United  States  but  the 
social  organization  has  never  been  developed  suffi- 


146  MENTAL  HYGIENE 

ciently  so  that  it  would  be  possible  to  find  a  way 
to  get  those  shoes  on  the  feet  that  needed  them.  As 
a  result  thousands  of  people  need  shoes  while  the 
wealth  of  the  community  as  a  whole  is  ample  to  pro- 
vide them.  If  the  unproductive,  defective,  very 
often  physically  sick  individuals  could  be  organized 
into  productive  units  it  would  be  of  inestimable 
benefit  both  to  them  and  to  the  community,  for  they 
would  cease  to  be  just  burdens  but  would  develop 
more  or  less  proficiency  in  each  instance,  so  that 
from  representing  a  zero  value  as  an  asset  their 
value  would  rise  in  many  instances  to  an  hundred 
per  cent,  as  based  on  capacity  for  self-support  as 
represented  in  earning  capacity,  or  some  fraction 
of  that. 

With  the  establishment  of  a  sympathetic  attitude 
on  the  part  of  the  public  to  prison  reform  along 
the  lines  I  have  indicated,  helped  along  by  the  work 
of  the  juvenile  courts  and  the  psychological  investi- 
gation of  juveniles  and  the  psychological  laborato- 
ries for  studying  criminals,  such  as  that  recently 
established  in  New  York  City,  it  may  be  possible 
to  go  further  and  do  something  about  the  method  of 
criminal  procedure  and  also  something  to  modify 
the  machinery  of  the  courts,  district  attorneys' 
office,  police  departments,  etc. 

Among  the  changes  which  are  needed  are  ade- 
quate courses  in  the  law  schools  to  properly  equip 
the  graduate  to  attack  the  various  social  problems 
centred  about  crime  in  a  manner  commensurate  with 
present-day  knowledge.    In  many  schools  little  or 


THE  CRIMINAL  147 

no  effort  is  made  to  do  this.  The  schools  teach  the 
law  as  it  is  and  as  it  has  been  interpreted  with 
little  effort  to  point  out  its  usefulness  in  the  social 
scheme  of  things  or  its  relations  to  other  disciplines. 
This  is  partly  due  to  and  partly  the  cause  of  the 
lack  of  interest  ordinarily  taken  in  criminal  law. 
The  average  law  student  appreciates  that  there  is 
no  career  and  no  money  for  the  man  who  makes  a 
specialty  of  criminal  law.  There  are  no  public  posi- 
tions of  importance  except  those  in  the  District  At- 
torney's office,  and  in  private  practice  it  is  a  hope- 
less specialty  because  the  criminal  never  has  any 
money.  The  law  student  appreciates  from  the  start 
that  civil  practice  offers  the  only  prospect  of  suc- 
cess upon  anything  more  than  a  mediocre  scale. 
Even  the  post  of  District  Attorney  itself  is  usually 
filled  from  considerations  of  political  expediency 
rather  than  of  personal  fitness. 

It  would  seem  from  a  consideration  of  the  prin- 
ciples and  the  facts  that  the  lines  along  which  de- 
velopment must  proceed  were  fairly  clear.  A  course 
in  the  psychology  of  evidence  has  been  a  part  of 
the  law  school  curriculum  in  a  number  of  European 
universities  for  some  years,  and  while  it  has  also 
found  its  way  to  the  United  States,  for  the  most  part 
it  still  goes  unrecognized  in  our  American  colleges. 
It  might  to  advantage,  I  think,  form  part  of  a  course 
on  human  behaviour  which  could  be  given  alike  to 
the  medical  and  the  law  students.  The  law  students 
might  also,  to  advantage,  and  this  is  also  done  in 
Munich  at  least,  attend  the  clinics  in  psychiatry. 


148  MENTAL  HYGIENE 

This  would  give  the  lawyer  some  first-hand  informa- 
tion, scientifically  presented,  of  what  mental  dis- 
ease really  is  and  help  him  to  understand  the  doc- 
tor's viewpoint.  As  it  is  today  the  attorney  and 
the  medical  expert  talk  different  languages  and 
many  difficulties  which  surround  the  whole  question 
of  expert  evidence  are  due  to  this  lack  of  the  two 
professions  to  comprehend  each  other.  Anything 
that  will  help  to  bring  about  a  mutual  understand- 
ing will  be  helpful  for,  as  I  have  already  intimated, 
reforms  in  law  can  only  come  about  after  reforms  in 
practice.  This  principle  I  shall  discuss  more  fully 
in  a  later  chapter,  but  it  seems  quite  clear  that  this 
is  the  course  that  events  must  take.  I  have  already 
illustrated  how  and  why  juries  often  bring  in  ver- 
dicts which  disregard  the  law  altogether.  Such  ver- 
dicts are,  as  a  rule,  I  think,  advances  over  the  literal 
interpretation  of  the  law  and  are  forced  by  public 
opinion  when  it  has  advanced  beyond  the  period  in 
which  the  law  was  enacted.  The  law  might  be  said 
to  always  follow,  never  to  lead,  the  practice. 

In  addition  to  courses  in  the  psychology  of  evi- 
dence, human  behaviour,  and  psychiatry  there  should 
also  be  a  course  in  sociology  with  special  emphasis 
on  criminology.  This  last  might  perhaps  be  a  post- 
graduate course  for  those  who  were  going  to  special- 
ize in  criminal  law. 

All  of  these  advances  will  probably  only  come 
about  contemporaneously  with  an  improvement  in 
the  status  of  the  District  Attorney  and  such  other 
public  officers  as  might  be  needed  in  dealing  with 


THE  CRIMINAL  149 

the  problem  of  crimeJ  The  District  Attorney 
should  receive  his  appointment  solely  upon  a  fitness 
basis  based  upon  his  special  knowledge  of  the  prob- 
lem he  is  to  undertake.  I  should  say  the  position 
should  have  a  Civil  Service  status  to  insure  perma- 
nency of  tenure,  during  good  behaviour  and  efficient 
conduct  of  the  office,  as  far  as  possible.  Such  a 
change  as  this  is  sorely  needed,  for  the  position 
nowadays  is  not  only  a  political  one  but  because  of 
that  fact  is  used  by  the  occupant  as  an  opportunity 
to  exploit  himself  in  such  a  manner  as  will  be  to  his 
greatest  personal  interest  when  he  comes  to  enter 
private  practice.  In  this  way  the  office  becomes 
primarily  a  means  of  personal  gain  rather  than  of 
public  service. 

I  think  also,  and  this  I  recognize  is  a  long  ways 
off,  that  the  District  Attorney  should  spend  one 
year  to  eighteen  months  as  an  interne  in  one  or  more 
penal  institutions  before  taking  office,  and  I  would 
consider  it  highly  desirable  to  extend  this  require- 
ment to  the  judge  sitting  in  criminal  court.  I  do 
not  see  how  it  is  possible,  by  any  other  method,  for 
these  officials  to  have  any  adequate  idea  of  the  na- 
ture of  the  human  material  which  they  are  called 
upon  to  deal  with.  This  principle  has  always  been 
appreciated  by  the  physician  and  I  do  not  see  why 
it  should  not  be  extended  to  the  lawyers.  As  it  is 
today  the  judge  who  is  to  sit  in  the  criminal  court 
is  chosen,  not  because  of  any  special  qualifications 
for  that  particular  service,  but  usually  because  he  is 

■7  For  example  a  public  defender. 


150  MENTAL  HYGIENE 

the  junior  member  of  the  bench.  The  work  is  con- 
sidered least  agreeable  and  therefore  is  relegated  to 
the  new  appointee. 

Perhaps  after  all  these  things  are  done  it  will 
be  possible  to  secure  some  changes  in  procedure. 
I  will  mention  only  two.  To  the  ordinary  man,  con- 
fronted with  the  rules  of  evidence  in  a  criminal 
procedure,  it  seems  as  if  the  rules  were  especially 
constructed  to  rule  out  every  single  matter  which 
the  average  man,  left  to  his  own  devices,  would  con- 
sider of  importance  and  would  utilize.  For  ex- 
ample: A  man  has  stolen  a  loaf  of  bread.  Evi- 
dence that  he  was  starving,  that  his  family  were 
starving,  that  he  had  tried  and  been  unable  to  obtain 
work,  etc.,  all  such  evidence  is  on  principle  ruled 
out,  and  yet  it  must  be  perfectly  evident  that  no 
understanding  of  the  situation  whatever  can  be 
gained  without  it.  I  know  that  I  am  treading  upon 
debatable  ground  and  that  a  lawyer  could  present 
a  good  case  to  the  contrary,  but  I  believe  that  this 
lawyer's  good  case  must  soon  go  the  way  of  all  good 
things  that  have  served  their  purpose — it  must  be 
superseded  by  something  better.  It  is  all  very  well 
for  society  to  close  its  eyes  in  seeming  complacency 
to  the  social  problem  such  a  case  presents  and  re- 
fuse to  see  it  by  ruling  out  the  evidence,  but  some 
day  it  will  be  just  as  pertinent  to  ask — ^why  is  it 
that  this  man  is  starving  amongst  you? — as  it  is 
today  to  ask  the  questions  which  are  admissible. 

As  we  have  seen,  the  fundamental  defect  of  the 


THE  CRIMINAL  151 

criminal  law,  from  the  point  of  view  of  the  changes 
which  I  advocate,  is  that  it  deals  with  the  crime 
and  not  with  the  criminal.  For  example:  A  boy 
snatches  a  pocketbook  without  knowing  what  its 
contents  are.  If  the  book  contained  less  than 
thirty-five  dollars  he  could  only  be  imprisoned  for 
a  period  not  to  exceed  one  year,  while  if  it  con- 
tained more  than  thirty-five  dollars  he  might  be  im- 
prisoned for  as  much  as  ten  years,  but  not  less  than 
one  year.  This  despite  the  fact  that  in  the  first 
instance  the  thief  might  be  an  old  offender,  a  sea- 
soned criminal,  a  chronic  menace  to  the  peace  of 
the  community,  while  in  the  latter  case  the  offence 
might  be  the  first  committed  by  a  person  readily 
amenable  to  reform.  In  any  case,  the  character  of 
the  crime  as  thus  set  forth  in  this  example  is  purely 
arbitrary,  and  the  thief  could  only  be  considered 
constructively  to  have  intended  it. 

The  effort  to  arbitrarily  distinguish  crimes  as 
petit  larceny  and  grand  larceny,  as  in  the  example 
given  above,  for  instance,  will  always  lead  to  an 
arbitrary,  and  in  a  not  inconsiderable  degree,  un- 
just administration  of  justice.  Whether  a  partic- 
ular individual  ever  comes  within  the  purview  of 
the  criminal  law  is  largely  a  matter  of  accident  and 
depends  to  no  small  extent  upon  the  ingenuity  of 
the  offender.  Now,  while  the  object  of  the  crim- 
inal law  is,  or  should  be,  the  protection  of  society, 
the  important  question  to  be  solved  is  not  whether 
the  offender  stole  thirty-four  or  thirty-six  dollars, 


152  MENTAL  HYGIENE 

and  is  therefore  to  be  indicted  for  petit  or  grand 
larceny  respectively,  but,  What  manner  of  man 
is  he? 

In  order  to  answer  this  question  it  is  necessary 
to  make  an  analysis  of  the  individual,  and  the 
causes  leading  up  to  his  offence.  Only  after  this 
is  done  can  a  reasonable  conclusion  be  reached  as 
to  whether  the  offender  is  best  treated  as  a  menace 
to  society  and  put  in  prison,  whether  he  is  a  proper 
subject  for  reformatory  efforts,  or  whether  he  might 
better  be  paroled  with  a  suspended  sentence. 

We,  as  physicians,  do  not  always  prescribe  the 
same  drug  in  the  same  dose  for  a  given  disease,  no 
matter  in  whom  it  may  occur,  vigorous  youth  or 
decrepit  old  man.  We  treat  the  patient,  not  the 
disease,  and  so  in  criminology  we  will  never  make 
any  further  progress  under  the  system  of  dealing 
with  the  crime  in  the  abstract,  we  must  learn  to 
treat  the  criminal. 

In  order  to  divorce  criminal  procedure  from  the 
practice  of  dealing  with  the  crime  instead  of  the 
criminal,  the  assistance  of  experts  in  mental  dis- 
orders and  in  criminology  must  be  sought,  and  I 
believe  it  is  the  duty  of  the  State  to  furnish  this 
assistance,  so  that  it  may  discharge  its  responsibili- 
ties both  to  society  and  the  criminal  intelligently. 
This  assistance  can  hardly  be  expected  from  the 
jury  or  from  the  overworked  court;  it  must  come 
from  a  special  body  of  men  whose  business  it  is  to 
furnish  it. 


THE  CRIMINAL  153 

These  preliminary  considerations  lead  logically 
and,  I  think  inevitably,  to  the  conclusion  that  the 
function  of  the  jury  should  end  with  establishing  the 
fact  that  an  offence  has  been  committed  by  the  ac- 
cused. This  fact  being  established  should  give  the 
State  authority  over  the  person  of  the  offender,  and 
he  should  be  taken  into  custody,  dealt  with  accord- 
ing to  the  sort  of  person  he  is,  and  not  turned  back 
into  the  community  until  he  may  be  with  safety, 
and  such  action  should  be  as  little  as  possible  de 
pendent  upon  the  degree  of  crime  as  now  defined. 

Given  then  an  individual,  the  jury  determines  that 
he  has  in  fact  committed  an  antisocial  act.  He  is 
then  remanded  to  a  court  or  committee  or  whatever 
else  it  may  be  advisable  to  call  it,  who  make  a  full 
report  to  the  trial  judge  upon  the  character  of  the 
offender  with  recommendations  for  treatment,  such 
recommendations,  so  that  the  amenities  may  be  pre- 
served, to  be  advisory  and  not  controlling.  On  the 
basis  of  this  report  the  judge  pronounces  sentence. 

Reduced  to  its  simplest  terms  the  whole  situa- 
tion is  just  this:  An  individual  commits  an  anti- 
social act.  By  so  doing  the  State  assumes  control 
of  his  person  and  liberty.  It  does  this  primarily 
because  it  has  a  right  to  protect  itself  from  his  dep- 
redations. Having  done  so  and  protected  itself, 
however,  it  has  a  further  duty  both  to  the  individual 
and  to  the  community.  It  must  endeavour  to  re- 
store the  offender  to  useful  citizenship  if  that  is 
possible.    In  other  words,  it  must  prescribe  a  form 


154  MENTAL  HYGIENE 

of  treatment  suitable  to  his  ailment.  In  order  to 
do  this  his  case  must  be  diagnosticated.  All  this 
is  clearly  the  duty  of  the  State. 

Society  has  too  long  dealt  with  crime,  either  from 
the  standpoint  of  revenge — the  principle  of  ''an  eye 
for  an  eye,  a  tooth  for  a  tooth,  "is  the  principle 
upon  which  our  criminal  code  is  built  and  which 
controls  much  of  its  application  even  today — or 
from  the  standpoint  of  a  disagreeable  affair  with 
which  the  easiest  way  is  the  best,  and  so  it  locks  up 
the  culprit,  turns  its  back  upon  him,  and  tries  to 
forget  all  about  it. 

The  time  has  passed  for  either  one  of  these  atti- 
tudes. Revenge  may  be  sweet,  but  it  is  usually  a 
pretty  expensive  indulgence.  Crime  is  a  social 
phenomenon  and  demands  attention  if  for  no  other 
than  economic  reasons.  It  is  distinctly  an  unwise 
policy  that  continues  a  system  which  actually  makes 
criminals.  What  else  can  be  expected  when  a  young 
boy  for  his  first  offence  is  ruthlessly  shut  up  in 
prison  to  associate  exclusively  for  months  with  a 
collection  of  the  worst  and  most  incorrigible  offend- 
ers 1  It  is  a  distinct  duty,  pointed  to  by  actual  dol- 
lars and  cents  economy,  to  keep  men  out  of  prison, 
or  if  they  get  in  to  restore  them  to  independence 
at  the  earliest  possible  date.  These  results  will 
never  take  place  until  we  learn  to  deal  with  the 
criminal  and  not  the  crime. 

This  would  seem  to  be  the  rational  method  for 
the  State  to  pursue.  How  can  it  best  be  accom- 
plished? 


THE  CRIMINAL  155 

If  insanity  is  the  defence  the  defendant  should  be 
sent  to  the  nearest  State  hospital  for  the  insane. 
Surely  if  a  person  is  insane  the  place  for  him  is  in 
an  institution  for  the  insane  and  not  in  a  jail.  Not 
only  this,  but  only  under  the  close  observation  pos- 
sible in  a  hospital  can  the  best  results  as  to  the 
diagnosis  of  the  condition  be  expected. 

This  method  of  procedure  I  believe  would  be  a 
good  one,  even  if  the  conclusions  of  the  State  hos- 
pital authorities  were  not  considered  final,  but 
merely  introduced  in  evidence  to  be  combatted  like 
other  evidence.  Under  such  circumstances  they 
would  easily  have  a  preponderating  influence  as 
coming  from  an  entirely  unbiased  quarter. 

This  sending  of  the  patient  to  a  State  hospital 
for  a  report  on  his  condition  may  be  delayed  until 
the  jury  has  returned  a  verdict  if  thought  best  to 
preserve  the  rights  of  the  accused.  Sentence  will 
be  passed,  or  from  our  viewpoint,  a  line  of  treat- 
ment prescribed,  only  after  a  diagnosis  has  been 
reached. 

In  order  that  the  State  hospitals  may  be  able  to 
meet  this  class  of  problems,  I  believe  each  one  should 
have  specially  constructed  quarters,  or,  better,  a 
special  group  for  the  observation,  care,  and  treat- 
ment of  this  class  of  cases.  A  special  detached 
group  would  probably  be  warranted  in  all  the  larger 
State  hospitals,  for  in  this  group  would  naturally 
be  cared  for,  in  addition  to  the  ** court  cases,"  the 
several  vicious  characters  of  the  insane  population, 
of  which  each  institution  always  has  a  number. 


156  •        MENTAL  HYGIENE 

TMs  grouping  of  the  noncriminal  with  the  crim- 
inal insane  may  be  objected  to  by  some.  It  is,  how- 
ever, an  entirely  reasonable  procedure  when  it  is 
considered  that  we  are  dealing  with  the  individual 
in  each  instance  and  not  the  isolated  result  of  some 
one  of  his  acts.  Whether  a  given  person  comes 
within  the  purview  of  the  criminal  law  or  not  is 
often  purely  a  matter  of  accident.  The  point  to  be 
considered  solely  is  the  character  of  the  person  he 
is,  and  if  he  has  manifest  criminal  and  vicious  tend- 
encies he  should  be  separated  from  the  general 
population  of  the  hospital  and  cared  for  with  his 
like. 

These  are  lines  along  which,  in  my  opinion,  we 
may  look  for  betterment  of  present  conditions. 
There  are  already  plenty  of  well  recognized  prin- 
ciples of  criminology  which  have  yet  to  be  adopted 
in  many  communities.  A  parole  system  and  the  in- 
determinate sentence  are  among  the  most  impor- 
tant. The  principles  underlying  these,  however,  are 
pretty  generally  accepted  and  for  the  most  part 
they  are  being  adopted  as  fast  as  circumstances 
admit,  that  is,  as  rapidly  as  the  general  enlighten- 
ment in  the  several  communities  call  for  such  meas- 
ures. They  do  not,  therefore,  require  to  be  argued 
in  this  connection. 

SUMMAEY 

The  distinction  between  conduct  which  is  regarded 
as  insane  and  conduct  which  is  regarded  as  criminal 
is  based  upon  the  herd  critique  and  "insane"  and 


THE  CRIMINAL  157 

"criminal"  are  in  fact  projected  opinions  of  Ihe 
herd. 

The  herd  critique  results  in  an  attitude  of 
leniency  toward  conduct  which  is  * '  insane ' '  because 
it  is  regarded  as  unpsychological,  that  is,  so  strange 
or  grotesque  that  it  is  not  considered  a  possible 
means  of  expression  and  therefore  must  be  the  re- 
sult of  illness.  Criminal  conduct  on  the  other  hand 
does  not  create  the  impression  of  being  unpsycho- 
logical,  strange,  or  grotesque  but,  on  the  contrary, 
is  considered  a  possible  means  of  expression  and 
therefore,  as  this  realization  has  to  be  repressed, 
fought  off,  hate  is  brought  to  the  task  and  criminal 
conduct  is  not  considered  leniently  but  as  a  form 
of  behaviour  which  calls  for  punishment. 

The  law,  by  considering  the  crime  rather  than  the 
criminal,  tends  to  the  perpetuation  of  this  method 
of  expression. 

Change  in  the  law  and  the  methods  of  criminal 
procedure  are  difficult  in  proportion  to  the  difficulty 
of  giving  up  this  method  of  expression  by  the  herd. 
Society  tends  to  hang  on  to  this  way  by  means  of 
which  it  can  continue  to  give  expression  to  its  hate. 
The  criminal,  therefore,  becomes  the  scapegoat  for 
the  herd. 

Eeform  had  thus  best  start  in  some  other  part  of 
the  system.  Prison  reform  is  suggested  because 
society  will  have  had  its  fling  at  the  criminal  and 
forgotten  him  and  then  something  may  be  done  for 
him. 

Not  to  rehabilitate  the  criminal,  when  possible,  is 


158  MENTAL  HYGIENE 

economically  and  otherwise  a  disastrous  policy  not 
only  for  the  individual  but  for  the  herd  when  the 
results  are  considered  in  terms  of  efficiency. 

The  principle  upon  which  the  rehabilitation  of  the 
prisoner  must  proceed  is  that  he  should  be  pre- 
pared, while  in  confinement,  to  exercise  those  func- 
tions that  he  will  have  to  exercise  when  he  is  dis- 
charged if  he  is  to  make  a  good  citizen.  He  can 
only  be  so  prepared  by  being  given  an  opportu- 
nity to  use  those  faculties. 

After  a  plan  has  been  worked  out  for  the  re- 
habilitation of  the  prisoner,  and  that  plan  has 
proven  successful  in  practice,  then  perhaps  it  will 
be  possible  to  approach  the  problem  of  criminal 
procedure  with  some  assurance  of  being  able  to  do 
something. 

The  change  in  criminal  procedure  should  be  a 
change  from  a  consideration  of  the  act  to  a  con- 
sideration of  the  prisoner  as  a  human  individual  and 
as  an  integral  part  of  society.  He  should  thus  be 
dealt  with  in  a  way  that  will  best  serve  both,  with,  of 
course,  adherence  to  the  principle  that  when  their 
two  interests  cross  the  interests  of  the  individual 
must  give  way  to  the  interests  of  society. 


CHAPTER  VI 
THE  FEEBLE-MINDED 

Of  a  considerable  number  of  terms  which  might 
have  been  employed  to  designate  the  group  I  shall 
discuss  in  this  chapter  I  have  chosen  feeble-minded 
as  perhaps  indicating  more  accurately  than  any 
other  the  idea  I  wished  to  convey.  The  term,  how- 
ever, is,  and  must  be  a  compromise  because  there 
has  not  grown  up,  as  in  the  case  if  the  insane,  and 
the  criminal,  a  social  concept  and  a  method  of  pro- 
cedure for  labelling. 

In  general,  the  group  which  I  shall  call  feeble- 
minded includes  those  individuals  who  are  mentally 
deficient — that  is  inadequate  at  the  social  and  the 
psychological  levels  of  reaction — and  whose  defect 
is  due  rather  to  an  arrest  of  development  than  to 
a  destructive  process  in  later  life. 

This  definition  is  of  course  very  crude  and  is  only 
meant  to  apply  in  the  broadest  general  way.  The 
group  is  quite  as  heterogeneous  as  either  of  the 
others  already  considered,  and  before  proceeding 
with  the  discussion  it  is  absolutely  necessary  to  gain 
some  idea  of  what  sort  of  individuals  it  contains. 

In  the  first  place,  the  concept  of  arrest  of  develop- 
ment is  not  a  simple  one.  The  arrest  may  be  due 
to  inherent  defect  in  the  germ  plasm  itself,  and  so 

159 


160  MENTAL  HYGIENE 

be  hereditary  in  the  true  sense ;  or  it  may  be  due  to 
injury  to  the  brain  the  result  of  disease  before  birth, 
and  so  be  congenital  but  not  hereditary;  or  it  may  be 
due  to  injury  operating  upon  the  brain  during  the 
early  years  of  development.  All  sorts  of  injuries 
may  produce  such  results.  Physical  injuries  at  birth 
and  infections  either  pre-natal  or  during  infancy 
are  prominent  causes,  while  entirely  extraneous 
factors  such  as  an  inherited  deaf -mutism  may  result 
in  feeble-mindedness  if  this  serious  deprivation  is 
not  corrected  by  special  educational  efforts.  Simi- 
larly high  degrees  of  myopia  (short  sightedness), 
adenoids  (which  interfere  with  breathing),  and  a 
multitude  of  other  causes  may  operate.  However, 
this  is  not  the  place  for  a  discussion  of  the  pathology 
of  feeble-mindedness.  I  only  wished  to  give  some 
slight  idea  of  the  extreme  multiplicity  of  the  factors 
which  enter  into  its  production. 

From  this  brief  indication  of  the  variety  of  causes 
which  may  operate  to  produce  feeble-mindedness  it 
will  be  apparent  that  we  are  not  dealing  with  a  uni- 
tary concept  in  any  sense.  When  we  survey  the 
social  problems  into  which  feeble-mindedness  pro- 
jects itself  as  an  important  factor  this  is  further  em- 
phasized. These  problems  include,  not  only  those 
of  the  idiot,  imbecile,  and  feeble-minded  as  ordina- 
rily understood  and  as  found  in  institutions,  but  the 
problems  of  the  juvenile  delinquent,  the  criminal 
and  the  prostitute.  Of  these  two  latter  classes  re- 
cent surveys  would  seem  to  indicate  that  conserva- 
tively fifty  per  cent,  could  be  included  in  the  feeble- 


THE  FEEBLE-MINDED  161 

minded  group  by  ordinary  methods  of  examination 
which  would  be  generally  acceptable.  In  addition 
to  these  groups  there  are  the  backward  and  atypical 
children — for  the  most  part  at  present  problems  of 
our  school  system — and  a  percentage,  no  one  knows 
how  large,  of  the  vagabond,  unemployed  and  pau- 
per classes.  Add  to  these  a  considerable  number  of 
those  otherwise  classed  as  epileptics  and  some  idea 
of  the  complexity  of  the  problem  and  its  wide  rami- 
fications can  be  gained. 

Age — In  order  to  express  feeble-mindedness  in  a 
concrete  way,  a  way  that  would  indicate  the  degree 
of  feeble-mindedness  present  in  any  particular  case, 
a  standard  was  sought  in  the  relative  age  of  the 
individual.  Age,  as  ordinarily  understood,  means 
the  length  of  time  a  person  has  lived  since  his  birth. 
Thus  a  child  of  ten  years  of  age  has  completed  ten 
years  since  birth  but  not  eleven.  That  time  is  a 
very  inaccurate  measure  of  age  has  long  been  rec- 
ognized and  in  medicine  is  well  expressed  by  the 
saying  that  "a  man  is  as  old  as  his  arteries."  Age, 
therefore,  means  rather  the  amount  of  development 
which  has  been  attained  or,  as  in  the  matter  of  the 
arteries,  the  degree  of  wear  and  tear  manifest. 

That  people  develop  unequally  is  a  commonplace 
so  we  can  speak  of  their  age  in  terms  of  their 
development  rather  than  in  terms  of  years  lived 
since  birth  which,  to  differentiate  it  from  these  other 
ways  of  designating  age,  may  be  called  the  chrono- 
logical age.  From  the  point  of  view  of  the  develop- 
ment age  may  be  considered  as  showing  in  struc- 


162  MENTAL  HYGIENE 

ture  or  in  function  as  compared  with  what  is  con- 
ceived of  as  normal.  In  this  way  the  individual 
may  be  classed  as  having  a  certain  anatomical  age 
if  his  development  as  shown  structurally  corre- 
sponds roughly  to  the  normal  development  at  a  like 
period,  and,  in  the  same  way,  from  the  standpoint  of 
function  he  may  be  classed  as  having  a  certain  physi- 
ological age.  The  particular  functions,  however, 
which  are  of  special  importance  in  the  consideration 
of  feeble-mindedness  are  the  psychological  or  men- 
tal functions,  so  it  becomes  desirable  to  designate, 
if  possible,  the  mental  or  psychological  age  of  the 
individual  for  purposes  of  classifying  his  degree  of 
feeble-mindedness. 

The  most  ambitious  attempt  to  determine  the  psy- 
chological age  has  been  by  the  use  of  the  so-called 
Binet-Simon  measuring  scale  of  intelligence  which 
is  admittedly  useful  only  for  the  first  twelve  years. 
This  test  has  been  modified,  more  particularly  by 
Goddard,  and  other  tests  have  been  devised  by  many 
workers.  There  are,  for  example,  the  De  Sanctis 
tests  and  more  recently  the  Yerkes  point  scale,  while 
tests  for  special  purposes  have  been  devised  by 
Healy,  Whipple,  Fernald  and  a  host  of  others.  In 
short,  the  literature  of  mental  testing  has  grown 
to  enormous  proportions. 

The  questions  naturally  arise — What  is  the  net 
value  of  all  these  tests!  Do  they  serve  to  classify 
the  individual  in  an  at  all  accurate  way  as  to  the 
degree  of  mental  development?  These  questions 
may  be  answered  briefly.    In  the  first  place  the  vari- 


THE  FEEBLE-MINDED  163 

ous  series  of  tests  are  useful  in  skilful  hands.  That 
is,  in  the  hands  of  people  who  know  a  great  deal 
about  human  beings,  and  therefore,  by  that  same 
token,  need  the  tests  least,  they  have  a  value.  The 
converse  is  naturally  true.  In  the  hands  of  those 
without  such  knowledge  they  are  of  little  or  no 
value  and  perhaps  may  be  actually  a  dangerous  tool. 

As  to  the  second  question — Do  they  serve  to  give 
accurate  information  as  to  the  psychological  age? 
Of  course  it  is  possible  to  classfy  individuals  on  the 
basis  of  these  tests  and  by  giving  each  one  a  definite 
psychological  age  compare  them  to  the  development 
of  the  normal.  Unfortunately  that  is  about  all  that 
can  be  done.  Here,  as  we  have  seen  all  along,  the 
individual  must  be  considered  as  a  whole  and  not 
simply  just  one  particular  set  of  reactions.  If  a 
group  of  defectives  were  gathered  together,  all  of  the 
same  psychological  age  by  some  scheme  of  tests,  it 
would  be  found  that  they  had  little  or  nothing  else 
in  common  except  their  capacity  to  react  similarly 
to  the  tests.  Of  course  this  must  mean  that  the 
tests  are  altogether  inadequate,  which  is  the  fact. 
The  capacity  for  psychological  reaction  is  too  com- 
plex a  matter  to  be  crowded  together  into  the  an- 
swers to  a  couple  of  dozen  questions.  This  is  par- 
ticularly so  when  we  recall  that  the  tests  were  espe- 
cially devised  to  measure  the  intelligence.  Now  that 
we  have  come  to  some  understanding  of  the  impor- 
tance which  the  emotional  plays  in  life  this  limita- 
tion is  alone  enough  to  explain  their  failure. 

But  enough.     This  is  not  the  place  to  discuss  the 


164:  MENTAL  HYGIENE 

value  of  mental  tests.  I  merely  wanted  again  to 
emphasize  the  extreme  heterogeneity  of  the  group 
feeble-minded,  to  show  how  impossible  it  is  of  defi- 
nition, to  indicate  it  as  a  dynamic  concept  like  those 
other  large  groups  I  have  already  considered. 

It  was  David  Starr  Jordan  who  said  ^'A  good 
citizen  is  one  who  can  take  care  of  himself  and  has 
something  left  over  for  the  common  welfare.'' 
Perhaps  if  we  keep  this  statement  in  mind  and  think 
of  the  feeble-minded  as  being  inherently  unable  to 
care  for  themselves,  except  under  the  most  favour- 
able circumstances,  and  as,  therefore,  having  noth- 
ing left  over  for  the  common  welfare,  we  will  come 
as  near  as  possible  to  a  correct  attitude  towards  the 
group  although,  of  course,  we  should  find  that  even 
as  loose  a  designation  as  this  would  often  have  to 
be  stretched  to  fit  a  particular  case  and  not  infre- 
quently would  not  fit  even  then. 

Feeble-mindedness,  even  from  the  standpoint  of 
an  intelligence  measuring  scale,  is  a  relative  affair 
when  expressed  in  the  behaviour  of  an  individual, 
and  conduct  which  would  be  considered  normal  un- 
der certain  conditions  might  well  be  open  to  in- 
quiry, as  possibly  defective,  under  others. 

With  respect  to  this  defect  the  main  feature  is 
that  it  is  organically  conditioned,  for  every  inade- 
quate adjustment  may  be  thought  of  as  due  to  a 
defect  and  every  one  as  having  a  capacity  for  ad- 
justment at  some  level.  The  feeble-minded,  how- 
ever, have  an  organically  conditioned  defect  which 
renders  forever  impossible  an  adequate  adjustment 


THE  FEEBLE-MINDED  165 

to  the  social  requirements.  Still  we  must  think  of 
these  requirements  always,  not  as  a  fixed  quantity, 
but  as  representing  a  relationship  variable  within 
wide  limits.  So  again  it  is  the  relation,  individual- 
society,  which  is  the  important  thing  and  feeble- 
mindedness is  a  concept  which  includes  certain  or- 
ganically defective  individuals  who  can  not  develop 
this  relationship  to  the  point  of  being  able  to  care 
for  themselves. 

On  the  other  hand  we  must  not  think  of  the  feeble- 
minded as  being  necessarily  simply  children.  Some 
of  them  quite  truly  are,  but  for  the  most  part  they 
present  features  which  do  not  square  with  any  one 
period  of  development  as  already  intimated  in  dis- 
cussing age.  In  the  first  place  the  defect  is  not 
usually  a  horizontal  one,  so  to  speak,  involving  the 
whole  individual  at  a  certain  level.  The  defect  quite 
usually  is  more  pronounced  in  certain  respects  than 
in  others.  For  example,  the  emotional  defect  is 
much  more  pronounced  than  the  intellectual  in  many 
high  grade  defectives.  Then  again  the  development 
of  the  sexual  organs  to  the  possibility  of  adult  func- 
tioning with  the  corresponding  growth  of  the  sex 
craving  in  individuals  still  infantile  in  many  respects 
presents  a  grotesque  disharmony  quite  unlike  any 
normal  period  of  development.  Further  than  this, 
and  very  fundamental,  is  the  fact  that,  children 
though  they  may  be  when  viewed  from  the  stand- 
point of  their  development,  they  are  rarely  per- 
mitted to  lead  the  life  of  a  child  but  on  the  contrary 
are  forced,  as  a  rule  through  economic  necessity,  to 


166  MENTAL  HYGIENE 

take  up  the  adult  problems  of  self  maintenance. 
This  brings  us  back  again  to  the  fundamental  issue 
of  the  society-individual  relation  in  which  we  find 
the  individual  with  infantile  characters  attempting 
the  problems  of  adulthood.  The  resulting  picture 
is,  as  might  be  expected,  neither  that  of  a  normal 
child  nor  of  a  normal  adult. 

THE   COlsrCEPT   FEEBLE-MINDEDN-ESS 

Thus  far  we  have  come  to  certain  conclusions,  by 
considering  what  is  meant  by  age,  as  to  what  sort  of 
individuals  might  be  included  under  the  broad  des- 
ignation of  feeble-minded,  namely,  those  who,  be- 
cause of  an  inherent  defect,  inherited  or  acquired, 
have  never  developed  and  are  unable  to  develop  to 
a  degree  of  socially  efficient  conduct  sufficient  for 
self-support.  Even  from  this  viewpoint,  crudely 
outlined  as  it  is,  we  have  had  the  extreme  hetero- 
geneity of  the  group  forced  upon  our  attention. 
When,  however,  we  come  to  consider  the  question 
from  the  point  of  view  of  therapeutics  we  see  still 
further  evidences  of  complexity. 

As  soon  as  we  begin  to  look  at  the  various  prob- 
lems from  this  angle  we  will  see  that  the  problem  of 
feeble-mindedness  and  many  other  social  problems 
intradigitate,  as  it  were,  and  the  resulting  problems 
are  not  necessarily  problems  of  feeble-mindedness 
at  all.  For  example,  not  a  few  defectives  are  such 
because  of  the  effects  of  congenital  syphilis  upon 
the  central  nervous  system.  The  social  problem  of 
such  a  syphilitic  imbecile  is  not  primarily  the  prob- 


THE  FEEBLE-MINDED  167 

lem  of  imbecility  at  all  but  rather  the  much  larger 
problem  of  syphilis  of  which  imbecility,  in  this  par- 
ticular case,  is  only  incidental.  Syphilis  may  pro- 
duce all  sorts  of  disorders  but  in  this  case  the  most 
evident  result  happens  to  be  imbecility  so  that, 
although  the  patient  has  naturally  to  be  treated  for 
what  he  is,  the  real  social  question  is  the  larger  one 
of  syphilis.  Similarly  in  the  matter  of  head  injuries 
sustained  during  birth.  Such  injuries  may  produce 
an  arrest  of  development  and  so  imbecility,  but  the 
larger  question  is  the  way  to  handle  the  mechanical 
problems  of  delivery.  Again — in  the  South  many 
children  are  defective  just  because  they  have  not  the 
energy  sufficient  to  enable  them  to  give  attention  and 
to  learn.  The  problem  again  is  incidental  to  a 
larger  one,  namely  that  of  uncinariasis  (hook  worm 
infection)  which  produces  these  results  as  a  conse- 
quence of  its  effect  upon  the  general  health.  A  sim- 
ilar situation  arises  as  the  result  of  adenoids  with 
resulting  serious  interference  with  respiration. 
Causes  which  are  distinctly  more  psychological  are 
those  defects  in  the  sense  organs,  eye  and  ear,  which 
make  it  impossible  for  the  child  to  adequately  per- 
ceive the  environment  and  therefore  adequately  re- 
act to  it. 

In  the  case  of  syphilitic  defect  the  problem  is  a 
social  one  of  wide  ramifications — ^venereal  prophy- 
laxis ;  in  the  case  of  the  injury  at  birth  the  problem 
is  an  obstetrical  one :  in  the  hook  worm  infection  the 
problem  is  one  of  sanitation  applied  to  a  large  area 
with  all  of  its  infinite  complexities:  in  the  case  of 


168  MENTAL  HYGIENE 

the  adenoids  the  problem  is  surgical:  and  in  the 
case  of  the  defective  sense  organs  it  is  in  the  first 
instance  a  problem  for  the  specialist  (ophthalmolo- 
gist or  aurist),  and  finally  a  problem  for  the  edu- 
cator. 

Many  other  examples  could  of  course  be  given, 
particularly  examples  of  sordid  and  unhygienic  en- 
vironment with  perhaps  alcoholic  habits  at  a  tender 
age,  deprivation,  toxemia,  and  vicious  influences,  all 
of  which  only  add  emphasis  to  the  heterogeneity  and 
the  complexity  of  the  concept  and  the  problem  of 
feeble-mindedness. 

Heredity — The  questions  involved  in  the  concept 
of  heredity  have  in  recent  years  been  given  a  large 
measure  of  attention  based  very  largely  upon  the 
rebirth  of  the  Mendelian  law  and  its  application  to 
solving  the  problems  of  heredity  in  the  whole  biolog- 
ical field  including  the  human  species.  Feeble-mind- 
edness has  come  in  for  its  share  of  attention  from 
this  field  of  science  and  heredity  has  come  to  figure 
as  its  cause  par  excellence. 

Briefly  stated  the  theory  of  heredity  is  as  follows : 
There  are,  separated  off  from  the  body  as  a  whole 
(the  soma),  the  sex  cells,  made  up  of  what  is  known 
as  the  germ  plasm.  When  two  such  cells  from  op- 
posite sexes  unite  (fertilization)  the  mixed  germ 
plasm  resulting,  containing  as  it  does  germ  plasm 
stock  from  both  phylums  (the  stock  of  both  part- 
ners) contains  the  potentialities  for  the  develop- 
ment of  a  new  individual. 

The  germ  plasm  is  supposed  to  contain  minute 


THE  FEEBLE-MINDED  169 

material  particles  which  are  the  hereditary  carriers 
of  the  several  qualities  of  the  new  individual,  the 
so-called  determiners  and  these  determiners,  during 
the  stages  of  cell  division  by  which  the  material  for 
the  new  individual  is  sorted  out,  are  divided  up 
according  to  mathematical  ratios  which  give,  in  each 
instance,  a  certain  mathematically  expressible  de- 
gree of  probability  that  the  new  individual  will  or 
will  not  have  a  certain  quality  possessed  by  one  or 
other  of  the  parents. 

The  various  hereditary  ratios  have  been  worked 
out  with  considerable  accuracy  in  experimental  work 
done  with  many  plants  and  animals  and  the  attempt 
has  been  made  to  carry  over  the  conclusions  reached 
to  explain  the  phenomena  of  heredity  in  man. 

These  theories  of  heredity  have  largely  controlled 
thought  with  regard  to  the  practical  approach  to  the 
solution  of  the  feeble-minded  problem  despite  the 
fact,  which  I  have  already  pointed  out,  that  in  a  con- 
siderable number  of  cases  the  feeble-mindedness  is 
only  incidental  and  but  a  minor  part  of  an  entirely 
different  problem.  The  upshot  of  the  whole  matter 
is  that  feeble-mindedness  has  been  held,  for  the  most 
part  at  least,  to  indict  the  germ  plasm  and  therefore 
the  conclusion  has  been  reached  that  the  only  prac- 
tical attack  upon  the  question  must  be  an  attack  upon 
bad  strains  of  germ  plasm  wherever  found.  The 
essential  fallacy  of  this  position  I  shall  discuss  later 
when  I  come  in  the  next  section  to  a  consideration 
of  the  eugenic  solution  for  the  problem. 


170  MENTAL  HYGIENE 

THE   EUGENIC   SOLUTION 

The  solution  for  the  problem  of  the  feeble-minded 
offered  by  the  engenicist  is,  as  suggested,  an  attack 
upon  the  germ  plasm.  His  suggestion  is  to  bring 
the  particular  strain  of  germ  plasm  which  has  been 
condemned  to  an  end  either  by  segregating  its  host 
during  the  period  of  sexual  potency  or  by  some  form 
of  surgical  procedure  which  will  cut  off  the  germ 
plasm  from  the  possibility  of  finding  its  complement 
for  reproduction  (castration  or  vasectomy  and  sal- 
pingectomy). 

This  solution  would  be  ideal  if  it  could  be  deter- 
mined that  a  certain  strain  of  germ  plasm  was  so 
bad  that  no  good  could  come  out  of  it.  But  such  a 
determination  is,  to  my  mind,  clearly  impossible. 
By  the  very  terms  of  the  theory  the  determiners 
which  carry  the  qualities  of  the  offspring  to  be  are 
segregated  according  to  mathematical  ratios,  there- 
fore just  because  a  person  may  be  no  good  in  one 
particular  that  by  no  means  implies  that  that  specific 
form  of  no-goodness  will  necessarily  be  transmitted 
to  any  or  all  descendants.  All  we  can  be  sure  of, 
accepting  the  theory,  is  that  as  a  result  of  diseased 
germ  plasm  a  certain  proportion  of  the  progeny  will 
be  diseased  but  just  which  ones  they  will  be  can  not 
he  predicted.  These  laws  of  heredity  are  useful  to 
explain  what  has  happened  but  of  almost  no  value  in 
predicting  what  will  happen  as  the  result  of  a  par- 
ticular human  fertilization.  Of  course  it  can  be  un- 
derstood how  these  laws  are  useful  to  fruit  raisers, 
for  example,  who  can  tell  just  what  proportion  of  a 


THE  FEEBLE-MINDED  171 

given  type  of  result  is  to  be  expected  in,  say  ten 
thousand,  plants  but  that  is  a  very  different  thing 
from  predicting  what  is  going  to  take  place  in  a 
single,  specific  instance. 

Then  again,  in  order  to  have  any  adequate  basis 
at  all  for  prediction,  it  is  necessary  to  know  the  qual- 
ities of  germ  plasm  which  enter  into  the  union  from 
both  stocks.  In  other  words,  no  prediction  at  all 
can  be  made  with  respect  to  the  progeny  of  a  given 
individual  unless  we  have  an  equal  amount  of  knowl- 
edge of  his  mate.  As  such  knowledge,  in  the  nature 
of  the  case,  is  not  usually  forthcoming  prediction  is 
out  of  the  question.  Those  who  favour  sterilization 
do  so  with  respect  to  the  quality  of  the  individual 
germ  plasm  yet  in  accordance  with  the  theory  there 
should  be  a  mathematically  determinable  comple- 
mentary germ  plasm  which  would  give  a  proportion 
of  healthy  individuals. 

Further  than  this,  we  are  by  no  means  sure  just 
what  qualities  may  be  represented  in  the  germ  plasm 
by  determiners,  and  even  though  we  are  clear  in  a 
given  instance  the  results  are  still  further  compli- 
cated by  the  phenomena  of  dominance  and  recessive- 
ness ;  that  is,  under  certain  circumstances  when  two 
determiners  clash  one  asserts  itself  (the  dominant) 
over  the  other  (the  recessive).  Under  certain  cir- 
cumstances, therefore,  a  trait  that  may  be  inherited 
will  assert  itself  (dominance)  while  under  others  it 
will  not,  it  is  dormant  (recessive). 

Aside  from  all  these  difficulties  the  eugenicists 
have  attempted  to  deal  with  the  question  of  feeble- 


172  MENTAL  HYGIENE 

mindedness  as  a  unitary  concept.  As  a  result  of 
this  they  formulated  a  law  some  time  since  that  the 
union  of  two  feeble-minded  persons  could  produce 
only  feeble-minded  progeny.  Soon  afterwards,  how- 
ever, there  were  found  exceptions  to  this  law  and 
the  explanation  was  that  if  one  parent  possessed 
certain  qualities,  a.  b.  c.  but  lacked  d.  which  lack 
produced  the  feeble-mindedness  in  this  particular 
instance,  and  the  other  parent  possessed  certain 
qualities,  a.  b.  d.  but  lacked  c.  which  produced  the 
feeble-mindedness  in  this  instance,  then  obviously 
the  child  might  possess  all  four  qualities  a.  b.  c.  d. 
deriving  the  quality  c.  from  the  first  parents  and  the 
quality  d.  from  the  second. 

It  is  unnecessary  to  further  contend  against  the 
idea  that  insanity,  criminality,  or  feeble-mindedness 
are  unitary  concepts.  This  whole  book  is  an  argu- 
ment against  the  possibility  of  maintaining  any  such 
position.  To  talk  about  insanity,  crime,  and  feeble- 
mindedness as  if  they  were  unit  characters  which 
could  be  transmitted  in  toto  is  to  fail  utterly  to  grasp 
the  meaning  of  these  phenomena  in  the  social  organ- 
ism, and  is  assuming  a  position  which  is  absolutely 
indefensible  and  untenable.  Everything  I  have  said 
about  these  three  groups  contradicts  it. 

That  the  error  of  such  practice  is  a  real  error 
and  not  merely  a  theoretical  one  is  easily  demon- 
strated. To  note  but  a  few  instances  taken  from 
Walter  :i 

1  H.  E.  Walter :  "Genetics,  An  Introduction  to  the  Study  of  Hered- 
ity."   New  York,  The  Macmillan  Co.,  1913. 


THE  FEEBLE-MINDED  173 

"The  list  of  weakling  babies,  for  instance,  who 
were  apparently  physically  unfit  and  hardly  worth 
raising  upon  first  judgment,  but  who  afterwards  be- 
came powerful  factors  in  the  world's  progress,  is  a 
notable  one  and  includes  the  names  of  Calvin,  New- 
ton, Heine,  Voltaire,  Herbert  Spencer  and  Robert 
Louis  Stevenson. 

' '  Or  take  another  example.  Elizabeth  Tuttle,  the 
grandmother  of  Jonathan  Edwards  is  described  as 
'a  woman  of  great  beauty,  of  tall  and  commanding 
appearance,  striking  carriage,  of  strong  will,  ex- 
treme intellectual  vigour, '  but  with  an  extraordinary 
deficiency  in  moral  sense.  She  was  divorced  from 
her  husband  'on  the  ground  of  adultery  and  other 
immoralities.  .  .  .  The  evil  trait  was  in  the  blood, 
for  one  of  her  sisters  murdered  her  own  son,  and  a 
brother  murdered  his  own  sister.'  That  Jonathan 
Edwards  owed  his  remarkable  qualities  largely  to 
his  grandmother  is  shown  by  the  fact  that  Eichard 
Edwards,  the  grandfather,  married  again  after  his 
divorce,  but  none  of  their  numerous  progeny  'rose 
above  mediocrity,  and  their  descendants  gained  no 
abiding  reputation.'  As  shown  by  subsequent 
events,  it  would  have  been  a  great  eugenic  mistake 
to  have  deprived  the  world  of  Elizabeth  Tuttle 's 
germ  plasm,  although  it  would  have  been  easy  to 
find  judges  to  condemn  her. ' '  ^ 

2  The  descendants  of  Jonathan  Edwards  are  described  by  Winship 
as  follows:  "1394  of  his  descendants  were  identified  in  1900,  of 
Whom  295  were  college  graduates;  13  presidents  of  our  greatest  col- 
leges, besides  many  principals  of  other  important  educational  insti- 
tutions; 60  physicians,  many  of  whom  were  eminent;   100  and  more 


174  MENTAL  HYGIENE 

In  the  old  Puritan  days  there  would  probably  have 
been  a  pretty  complete  unanimity  of  opinion  that  a 
girl  who  smoked  cigarettes  or  danced,  or  a  boy  who 
chopped  wood  on  Sundays,  or  a  man  who  had  doubts 
as  to  the  literal  truth  of  the  Bible  were  all  sure  of 
eternal  punishment  in  Hell  and  that  they  pretty  well 
deserved  it.  Today,  however,  while  we  might  per- 
sonally agree  or  disagree,  approve  or  disapprove  of 
these  several  persons  we  would  hardly  feel  war- 
ranted in  cutting  off  their  germ  plasm  from  the  world 
although  in  the  old  days,  if  such  a  course  of  pro- 
cedure had  been  suggested,  I  feel  sure  it  would  have 
found  many  hearty  sponsors. 

The  reader  should  be  prepared  by  this  time,  if  he 
has  followed  the  thought  which  runs  through  the 
book  up  to  this  point,  to  realize  that  what  is  right  or 
wrong,  what  is  good  or  bad  is  very  much  what  we 
think  to  be  right  and  wrong,  good  and  bad,  so  that 

clergymen,  missionaries,  or  theological  professors;  75  were  officers 
in  the  army  and  navy;  60  were  prominent  authors  and  writers,  by 
whom  135  books  of  merit  were  written  and  published  and  18  im- 
portant periodicals  edited;  33  American  States  and  several  foreign 
countries  and  92  American  cities  and  many  foreign  cities  have 
profited  by  the  beneficient  influence  of  their  eminent  activity;  100 
and  more  were  lav^yers,  of  whom  one  was  our  most  eminent  pro- 
fessor of  law;  30  were  judges;  80  held  public  office,  of  whom  one 
was  vice-president  of  the  United  States;  3  were  United  States 
senators;  several  were  governors.  Members  of  Congress,  framers  of 
state  constitutions,  mayors  of  cities,  and  ministers  to  foreign  courts; 
one  was  president  of  the  Pacific  Mail  Steamship  Company;  15  rail- 
roads, many  banks,  insurance  companies,  and  large  industrial  enter- 
prises have  been  indebted  to  their  management.  Almost  if  not  every 
department  of  social  progress  and  of  public  weal  has  felt  the  impulse 
of  this  healthy,  long-lived  family.  It  is  not  known  that  any  one 
of  them  was  ever  convicted  of  crime." 


THE  FEEBLE-MINDED  175 

such  a  reaction  as  an  advocacy  of  castration  is  not  of 
necessity  free  from  the  criticism  that  it  seeks  to  cas- 
trate those  individuals  with  whom  it  finds  itself  in 
disagreement.  ' 'Agree  with  me  on  certain  points  of 
morals  or  be  castrated"  is  the  formula,  a  formula 
which  if  expressed  in  terms  of  religious  dissension  at 
the  time  of  the  Inquisition  is  not  at  all  exaggerated. 

But  social  habits,  usages,  customs — ^the  mores — 
change.  What  was  right  yesterday  is  wrong  tomor- 
row and  what  was  wrong  yesterday  is  right  today. 
Who  is  wise  enough  to  decide?  Looked  at  from  the 
point  of  view  of  energy  values  Elizabeth  Tuttle  was 
an  enormous  dynamic  force  as  her  progeny  well 
proved.  Perhaps  her  powers  were  ill  directed.  Is 
that  a  good  reason  for  destroying  them?  Would  it 
not  be  better  to  try  at  least  to  direct  them  into  better 
channels?  That,  at  least,  is  what  her  descendants 
did.  We  should  aim  at  similar  results,  taking  our 
cue  from  Nature. 

Aside  from  all  this  I  think  it  is  fair  to  presume 
that  a  great  deal  of  the  drudgery  of  the  world  is  done 
by  persons  who,  according  to  any  accepted  standard 
of  mental  measurement,  would  be  classified  as  feeble- 
minded. The  enormity  of  the  whole  project  comes 
plainly  in  view  when  we  learn  that  in  order  to  carry 
out  the  work  to  the  highest  efficiency  which  will  re- 
sult in  the  most  rabid  elimination  of  the  unfit  and 
consequent  regeneration  of  the  race,  that  ten  per 
cent,  of  the  population  would  have  to  be  sterilized, 
that  is,  in  this  country  ten  millions  of  people. 

All  this  sort  of  thinking  is  just  so  much  evidence  of 


176  MENTAL  HYGIENE 

that  tendency,  already  referred  to,  of  attempting  to 
crowd  life  into  dead  forms,  of  trying  to  think  of 
something  moving,  dynamic,  in  terms  of  something 
dead,  static.  Individual,  environment  are  not  mu- 
tually exclusive.  Man  is  only  a  bit  of  the  life  of  the 
world,  and  unless  he  is  seen  as  such  and  his  reactions 
viewed  from  that  standpoint  no  adequate  program 
of  dealing  with  his  reactions  can  be  worked  out.  We 
will  see  this  more  clearly  in  the  next  section. 

Sterilization  Legislation — The  advocates  of  laws 
which  shall  provide  for  the  sterilization  of  certain 
classes  of  defectives  are  labouring  under  a  peculiar 
delusion  of  the  nature  and  function  of  law  already 
hinted  at  in  the  chapter  on  the  criminal  in  the  section 
dealing  with  criminal  procedure.  The  whole  ques- 
tion of  the  place  of  law  in  dealing  with  the  larger 
question  of  mental  defect  needs  to  be  better  under- 
stood, and  because  of  the  emphasis  which  has  been 
recently  laid  upon  the  need  for  sterilization  laws  per- 
haps this  is  as  good  a  place  as  any  to  consider  it. 

I  have  already  intimated  that  law,  as  such,  was  not 
a  means  through  which  to  effect  reforms  by  stating 
the  general  proposition  that  practice  had  to  precede 
formal  enactment  into  statute.  In  fact  it  would 
seem  that  the  first  step  in  the  administration  of  jus- 
tice has  always  been  the  appointment  of  a  judge  and 
this  before  the  existence  of  formal,  written  law.^ 
Statutory  law  is  by  no  manner  of  means  a  body  of 

•3  James  C.  Carter :  "The  Ideal  and  the  Actual  in  the  Law,"  annual 
address  at  the  thirteenth  annual  meeting  of  the  American  Bar 
Association,  1890. 


THE  FEEBLE-MINDED  177 

commands  imposed  upon  society  from  without  but 
the  crystallized  expression  in  written  form  of  what 
was  already  nascent  in  the  social  consciousness,  what 
had  already  grown  from  within  and  was  waiting  to 
be  born,  to  be  embodied  in  concrete  form.  Unless, 
therefore,  the  written  law  expresses  the  desires  of 
the  people  it  can  be  nothing  else  than  a  dead  letter 
on  the  statute  books.  The  Honourable  Henry  E. 
Davis  *  has  expressed  the  general  principle  that  gov- 
ernment is  based  upon  the  consent  of  the  governed 
so  far  as  the  law  is  concerned  by  defining  law  as 
''That  body  of  rules  for  the  regulation  of  human 
conduct  which  is  enforced  by  the  State,  embodying 
so  much  of  the  attribute  of  justice  as  each  particular 
society  of  men  is  able  to  comprehend  and  willing  to 
apply  in  human  affairs." 

This  meaning  of  the  law,  namely,  that  it  must  be 
read  out  of  society,  not  into  it,  has  been  most  admir- 
ably expressed  by  the  Honourable  James  C.  Carter  ^ 
and  I  can  do  no  better  than  to  quote  from  his  address 
already  referred  to. 

''In  early  Rome,  and  in  every  other  instance  of 
which  we  have  authentic  information,  we  find  that 
the  first  step  in  the  administration  of  justice  has  been 
to  elect  a  judge.  The  creation  of  judges  everywhere 
antedates  the  existence  of  formal  law.  But  though 
formal  law  does  not  at  first  exist,  the  law  itself  ex- 
ists, or  there  would  be  no  occasion  to  appoint  a  judge 
to  administer  it.     The   social  standard  of  justice 

4  Of  the  District  of  Columbia  Bar. 

5  Loc.  cit. 


178  MENTAL  HYGIENE 

exists  in  the  habits,  customs  and  thoughts  of  the 
people,  and  all  that  is  needed  in  order  to  apply  it  to 
the  simple  affairs  of  such  a  period  is  the  selection  of 
a  person  for  a  judge  who  best  comprehends  those 
habits,  customs  and  thoughts.  .  .  . 

'*  Moreover,  the  only  means  open  to  us  of  certainly 
knowing  the  law,  namely,  a  resort  to  the  judge,  is 
available  only  in  the  case  of  an  alleged  violation; 
and  what  sort  of  a  command  is  that  which  must  be 
violated,  or  alleged  to  have  been  violated,  before  it 
can  be  known!  But,  if  law  be  not  a  command,  but 
the  mere  jural  form  of  the  habits,  usages  and 
thoughts  of  a  people,  the  maxim  that  all  are  pre- 
sumed to  know  it  does  not  express  a  false  assump- 
tion, but  a  manifest  truth.  .  .  . 

*'The  office  of  the  judge  is  not  to  make  it,  but  to 
find  it,  and,  when  it  is  found,  to  affix  to  it  his  official 
mark  by  which  it  becomes  more  certainly  known  and 
authenticated.  The  office  of  the  legislator  ...  is 
somewhat,  but  not  fundamentally,  different.  .  .  . 

''These  are  that  law  is  not  a  body  of  commands 
imposed  upon  society  from  without,  either  by  an 
individual  sovereign  or  superior,  or  by  a  sovereign 
body  constituted  by  representatives  of  society  itself. 
It  exists  at  all  times  as  one  of  the  elements  of  society 
springing  directly  from  habit  and  custom,  .  .  . 

' '  The  statute  law  is  the  fruit  of  the  conscious  exer- 
cise of  the  power  of  society,  while  the  unwritten  and 
customary  law  is  the  product  of  its  unconscious  ef- 
fort. The  former  is  indeed  to  a  certain  extent  a 
creative  work;  but,  as  we  have  already  seen,  the 


THE  FEEBLE-MINDED  179 

condition  of  its  efficacy  is  that  it  must  limit  itself  to 
the  office  of  aiding  and  supplementing  the  uncon- 
scious development  of  unwritten  law.  .  .  . 

**It  might  be  thought  that,  inasmuch  as  it  is  the 
sole  office  of  the  judicial  tribunals  to  find  existing 
customs  and  not  to  make  any,  they  could  not  effect 
improvements,  which  is  a  creative  function.  .  .  . 

**The  judge,  the  lawyer,  the  jurist  of  whatever 
name,  continually  occupied  in  the  work  of  examining 
transactions  and  determining  the  customs  to  which 
they  belong,  and  whether  to  those  which  society 
cherishes  and  favours,  or  to  those  which  it  con- 
demns, is  constantly  employed  in  the  contemplation 
of  what  is  fit,  useful,  convenient,  right — or,  to  use 
the  true  word,  just.  ... 

**As  custom  is  the  true  origin  of  law,  the  legisla- 
ture cannot,  ex  vi  termini,  absolutely  create  it.  This 
is  the  unconscious  work  of  society.  But  the  passage 
of  a  law  commanding  things  which  have  no  foun- 
dation in  existing  custom  would  be  only  an  en- 
deavour to  create  custom,  and  would  necessarily  be 
futile.  .  .  . 

''The  function  of  the  legislator  is  supplementory 
to  that  of  the  judge.  It  is  to  catch  the  new  and  grow- 
ing, but  imperfect,  customs  which  society  is  forming 
in  its  unconscious  eif  ort  to  repress  evils  and  improve 
its  condition — customs  of  the  existence  of  which  the 
judges  are  uncertain  and  at  variance,  or  which  are 
so  different  from  former  precedent  that  they  cannot 
declare  them  without  inconsistency — and  to  give  to 
these  formal  shape  and  ratification.  .  .  . 


180  MENTAL  HYGIENE 

**A  custom  begins  to  grow,  and  becomes  more  and 
more  general,  to  make  to  them  some  remuneration. 
It  is  not  universal.  The  judge  cannot,  consistently 
with  his  prior  declarations,  recognize  it ;  but  the  un- 
conscious forces  of  society  are  struggling  for  it,  and 
the  final  legislative  sanction  is  impatiently  awaited. 

''In  legislation,  therefore,  the  rule  should  be  never 
to  act  unless  there  is  an  end  to  be  gained  for  which 
legislative  action  alone  is  competent ;  and  when  such 
action  is  initiated,  it  should  seek  to  recognize  and 
express  the  customs  which  society  is  aiming  to  make 
uniform. ' ' 

From  all  this  the  futility  of  legislation  which  pro- 
vides for  the  sterilization  of  defectives  is  manifest.^ 
Law,  as  I  have  said,  is  only  capable  of  giving  effec- 
tive expression  to  what  is  already  nascent  in  the 
herd.  Law  is  not  an  avenue  through  which  to  effect 
reforms  but  a  means  of  fixing,  crystallizing  the  re- 
sults of  reforms  already  effected  in  the  social  con- 
sciousness and  merely  awaiting  the  sanction  of  leg- 
islative recognition  and  enactment. 

THE    MENACE    OF    FEEBLE-MINDEDNESS 

It  is  the  habit  in  certain  quarters  to  paint  alarmist 
pictures  of  the  menace  of  the  feeble-minded,  more 
especially  by  emphasizing  their  greater  productivity 
than  the  normal  and  the  further  fact  that  they  are 
being  cared  for  by  society  and  kept  alive  and  so  the 
means  of  their  elimination  are  prevented  from  pro- 

6  The  sterilization  laws  which  have  been  put  upon  the  statutes  in 
some  of  the  states  are  practically  inoperative. 


THE  FEEBLE-MINDED  181 

dncing  their  natural  consequences.  Whereas  I  do 
not  want  to  minimize  any  real  danger,  still  I  am  sure 
that  the  menace  has  been  greatly  overdrawn. 

In  the  first  place,  even  under  the  most  favourable 
conditions,  the  viability  of  the  feeble-minded  as  a 
class  is  below  that  of  the  normal  so  that  this  fact  has 
to  be  set  over  against  any  increased  productiveness 
that  they  may  show.  Their  capacity  for  life  is  be- 
low par  not  only  as  a  direct  consequence  of  their 
defective  physical  make-up  of  which  their  feeble- 
mindedness is  one  expression  and  which  makes  them 
relatively  non-resistant  to  disease,  but  also  because 
of  their  defective  intelligence  which  makes  them  in- 
capable of  adequately  dealing  with  sickness  when 
they  or  their  friends  or  relatives  are  affected.  A 
neglected  pain  in  the  abdomen  may  be  due  to  an 
acute  appendicitis  which  causes  death  but  which  was 
not  brought  to  the  attention  of  the  surgeon  early 
enough  because  of  the  defective  intelligence  of  the 
patient,  who  did  not  know  how  to  complain  or  of  his 
family  who  did  not  know  what  to  do  if  he  did  com- 
plain. 

It  is  the  same  with  the  care  of  the  children.  The 
feeble-minded  mother  takes  care  of  her  baby  much 
as  a  child  (to'  use  Dr.  Salmon's  apt  illustration) 
looks  after  its  doll.  She  is  quite  as  apt  to  forget 
about  it  and  leave  it  outdoors  somewhere  in  inclem- 
ent weather  with  disastrous  results. 

These  are  the  natural  ways  in  which  feeble-mind- 
edness  tends  to  eliminate  itself  and  which  many 
eugenists   think   are   being   negatived   by   present 


182  MENTAL  HYGIENE 

methods  of  public  care.  Of  course  they  are  not  be- 
ing negatived  to  any  great  extent  as  yet  because  only 
comparatively  few  of  the  feeble-minded  are  being 
publicly  cared  for,  but  the  principle  remains  the 
same  and  it  is  largely  because  of  these  reasons  that 
these  eugenists  are  so  insistent  upon  sterilization. 

The  more  rapid  multiplication  of  the  relatively  in- 
ferior seems  to  be  a  law  of  nature.  The  lower  down 
in  the  scale  of  life  we  go  the  greater  the  capacity  for 
reproduction  because  the  adaptability  is  less  and  the 
mortality  correspondingly  greater.  This  being  so  it 
would  look  as  if  there  were  some  ground  for  the 
eugenists'  fears  that  natural  means  of  elimination 
are  being  set  at  naught  by  public  care.  There  is  a 
certain  truth  in  this,  but  if  the  eugenists  are  right 
there  will  soon  be  no  one  but  feeble-minded  to  popu- 
late the  earth,  and  in  fact  it  would  seem  that  the 
mathematical  necessities  based  upon  their  fertility 
would  have  eliminated  all  others  long  before  this. 

The  fallacy  here  seems  to  be  fundamental,  namely, 
a  failure  to  see  f eeble-mindedness  as  a  relative  mat- 
ter and  the  act  of  caring  for  the  weaker  as  a  part 
of  social  activity  as  a  whole,  which  here  as  elsewhere 
all  along  the  line  of  development,  has  assured  the 
survival  and  the  dominance  of  those  best  equipped. 
The  attitude  of  the  eugenists  is  too  simplistic.  It 
fails  to  appreciate  the  enormous  complexity  of 
society  and  considers  that  a  single  factor  in  that 
complexity,  namely,  the  fertility  of  the  feeble- 
minded, can  be  considered  alone  and  that  its  results 
may  be  considered  as  coming  about  naturally  in  a 


THE  FEEBLE-MINDED  183 

society  in  wiiich  everything  else  remains  stationary. 

It  behooves  us,  therefore,  and  this  is  very  im- 
portant, not  only  here  but  as  we  shall  see  later  in 
connection  with  other  problems,  to  try  and  search 
out  the  natural  ways  in  which  the  race  tries  to  de- 
fend itself  from  the  deterioration  incident  to  feeble- 
mindedness. In  the  first  place  the  natural  resist- 
ance can  not  be  made  normal  by  care  nor  can  all  of 
the  danger  be  eliminated  which  is  dependent  upon 
the  mental  defect.  More  important  than  this,  how- 
ever, is  the  fact  brought  out  recently  by  Dr.  Walter 
E.  Fernald,''^  namely,  that  fifty  per  cent,  of  the  feeble- 
minded children  which  had  been  discharged  from  his 
institution  did  not  marry  and  did  not  have  children. 
As  soon  as  this  fact  is  stated  the  reason  for  it  is  at 
once  apparent.  The  feeble-minded  are  suffering 
from  a  serious  biological  defect,  and  one  of  the  most 
common  signs  of  such  serious  defect  is  an  incapacity 
for  meeting  normal  biological  demands  in  the 
matter  of  mating.  We  see  this  defect  constantly 
and  can  understand  how  it  must  be  apparent  in  an 
exaggerated  degree  among  the  feeble-minded. 

I  am  reminded  in  this  connection  of  the  views  ex- 
pressed by  a  gentleman,  also  engaged  in  the  care  of 
the  feeble-minded,  but  who  takes  a  stand  at  the 
opposite  extreme.  He  says,  for  example,  apropos 
of  the  danger  of  the  feeble-minded,  that  there  is  no 
danger  from  the  feeble-minded,  the  danger  arises 
from  the  unkind  and  unintelligent  things  that  people 
do  to  the  feeble-minded.    One  of  the  real  reasons 

1  Of  Waltham,  Mass. 


184  MENTAL  HYGIENE 

why  many  feeble-minded  persons  cannot  get  along 
in  the  community  is  because  they  are  not  let  alone. 
As  a  class  they  are  childlike,  tractable,  give  their 
confidence  and  affection  easily  and  if  properly  and 
kindly  handled  many  would  get  along  all  right.  The 
feeble-minded  boy,  however,  is  not  let  alone.  He  is 
teased  into  a  state  of  constant  irritability  and  finally 
in  an  excess  of  rage,  when  he  is  no  longer  able  to 
control  himself,  he  turns  about  and  strikes  the  cause 
of  his  sufferings  dead.  Then  the  community  says 
there  is  a  problem.  This,  of  course,  is  but  one  of 
those  artificial  problems  which  I  have  already  men- 
tioned and  which  should  not,  all  at  least,  be  laid  at 
the  door  of  the  feeble-minded.  Not  infrequently  the 
productivity  of  the  feeble-minded  is  as  much  an  ar- 
tificial problem  in  the  same  way.  The  feeble-minded 
girl  is  not  infrequently  but  the  passive  victim  either 
of  the  unscrupulous  seducer  or  the  adolescent  youth 
who  knows  no  better.  Here  again  the  fault  should 
not  all  be  laid  against  the  feeble-minded. 

I  feel  very  much  toward  the  question  of  steriliza- 
tion as  I  do  toward  the  proposition  to  chloroform  all 
the  insane  and  criminals.  The  dependents  are  the 
burdens  which  the  ejB&cient  have  to  bear  and  become 
efficient  in  bearing.  The  pain  and  the  suffering  they 
cause  have  ''forward  ends"  which  make  for  a  better 
and  more  humane  society.  Chloroform  might  be  a 
solution  but  I,  for  one,  would  not  like  to  live  in  a 
society  which  adopted  it. 

There  will  always  be  a  long  way  between  the  man 
at  the  top  of  the  ladder  and  the  man  at  the  foot,  and 


THE  FEEBLE-MINDED  185 

the  man  at  the  foot  will  relatively  speaking  be  feeble- 
minded. We  need  not  expect  to  eliminate  the  prob- 
lem but  we  must  be  satisfied  if  by  great  effort  we  can 
shorten  that  distance  just  a  little. 

WHAT   IS   TO   BE   DONE  ABOUT   IT? 

In  making  for  a  remedy  for  the  problem  of  feeble- 
mindedness we  must  of  course  keep  always  in  mind 
the  complexity  of  the  concept  and  never  make  the 
mistake  of  dealing  with  it  as  if  it  were  unitary.  As 
we  have  seen  that  the  factors  which  produce  feeble- 
mindedness are  many  so  must  the  remedies  be.  The 
remedy  for  adenoids  is  surgical ;  for  sensory  defect 
following  the  eruptive  fevers  is  sanitation;  for  de- 
fective eyesight  appropriate  glasses ;  for  vicious  sur- 
roundings with  no  opportunities  improved  environ- 
ment and  education,  etc.,  etc.  There  remains  a  large 
number  who  are  defective  because  of  serious  defect 
of  structure,  either  developmental  (hereditary)  or 
acquired  (disease,  injury).  How  shall  this  large 
group,  of  which  there  are  probably  some  three  or 
four  hundred  thousand  in  the  United  States,  not  in 
institutions,  be  dealt  with? 

In  the  first  place  I  have  already  unequivocally 
opposed  sterilization  as  a  solution  of  the  problem 
because  I  believe  it  to  be  unscientific,  unwarranted 
by  our  present  knowledge,  and  inhuman,  this  latter 
having  perhaps  a  more  serious  effect  upon  the 
society  which  sanctions  it  than  upon  the  defective 
who  has  to  submit,  although  as  yet  we  do  not  know 
the  extent  of  damage  which  such  operations  may 


186  MENTAL  HYGIENE 

produce.  I  believe  it  greater  than  generally  sup- 
posed. Certainly  we  do  not  yet  fully  know  the  pos- 
sibilities for  harm  at  the  psychological  level  of  reac- 
tion of  destroying  for  an  individual  all  possibility  of 
their  ever  fulfilling  their  biological  goal. 

Institution  care  of  course  suggests  itself  and  has 
been  and  is  being  pushed  forward  largely  as  a  solu- 
tion. Undoubtedly  many  cases  should  be  segregated 
in  proper  institutions.  Just  how  many  or  what  pro- 
portion we  do  not  know,  but  certainly  all  those  who 
are,  in  a  broad  sense,  actively  dangerous  to  the  so- 
cial welfare.  Such  cases,  for  example,  as  show  dan- 
gerous criminal  tendencies,  particularly  those  with 
tendencies  to  commit  crimes  against  the  person  (sex 
offenders),  those  which  are  distributors  of  venereal 
infection  (prostitutes),  and  those  which,  because  so 
defective  they  cannot  maintain  a  semblance  of  social 
efficiency,  live  in  such  squalor,  filth  and  depravity  as 
not  only  tends  to  degrade  the  neighbourhood  but 
makes  of  them  dangerous  foci  of  infection  which 
threaten  the  health  and  the  lives  of  the  community. 
These  should  be  the  first  to  be  prepared  for  by  insti- 
tution care. 

A  great  many  of  the  feeble-minded  besides  those 
described  will  be  able  to  live  outside  of  an  institu- 
tion. In  fact,  not  a  little  of  the  simple  sort  of  work, 
the  drudgery  of  life,  is  done  by  individuals  who,  by 
any  accepted  standard  of  measurement  would  un- 
doubtedly fall  within  the  feeble-minded  group. 

With  the  establishment  of  institutions,  however, 
many  of  distinctily  higher  grade  than  those  de- 


THE  FEEBLE-MINDED  187 

scribed  will  seek  admission,  many  who  could  theo- 
retically get  along  outside  under  the  reasonable 
care  of  the  family  but  who,  because  there  is  no  fam- 
ily, or  all  members  of  the  family  have  to  work,  or 
because  they  are  too  poor  to  support  the  burden,  or 
for  one  or  another  of  innumerable  reasons  will  need 
to  send  the  feeble-minded  member  to  an  institution. 
Thus  the  institution  will  at  once  remove  from  the 
community  those  individuals  who  are  an  immediate 
source  of  danger  to  it  and  in  addition  it  will  take 
those  individuals  who,  while  theoretically  they  might 
live  outside  for  some  reason  or  other  can  not  be  ade- 
quately cared  for  and  so,  both  as  a  matter  of  Common 
humanity  and  also  to  save  the  community  from  the 
dangers  of  which  these  individuals  may  be  the  in- 
direct cause  (infections),  require  to  be  cared  for. 

If,  now,  segregation  in  such  an  institution  is  by 
the  process  of  commitment  by  *'due  process  of  law" 
as  is  the  case  with  the  insane,  as  has  recently  been 
provided  by  legislation  in  Illinois,  it  will  be  possible 
to  keep  such  seriously  defective  individuals  at  least 
during  the  period  of  their  capacity  for  reproduction 
and  so  accomplish  quite  as  much  as  is  sought  by 
sterilization  without  doing  violence  either  to  the 
feeble-minded  or  the  best  sentiment  in  the  commu- 
nity. An  institution  which  would  do  this  would 
serve  the  very  best  interests  of  the  community  by  re- 
moving from  it  those  individuals  who  were  an  ab- 
solute dead  weight  and  interfered  most  with  free- 
dom and  progress. 

The  treatment  in  such  an  institution  offers  noth- 


188  MENTAL  HYGIENE 

ing  new  in  the  way  of  principles  involved.  The  ob- 
ject is  to  take  individuals  who  can  not  live  in  the 
social  environment  and  create  an  environment  for 
them  in  which  they  can  live,  and  not  only  live  but  at 
the  highest  efficiency  of  which  they  are  capable.  The 
environment  has,  of  course,  to  be  made  simple 
enough  to  meet  their  level  of  development  and  as  far 
as  possible  adjusted  to  individual  needs. 

Education  will  naturally  play  a  large  part  in  deal- 
ing with  this  class  of  defectives.  In  order  that  they 
may  live  at  their  best  dormant  and  neglected  facul- 
ties must  be  developed  to  capacity.  The  process  of 
education  going  hand  in  hand  with  useful  occupation 
will  enable  all  to  get  the  most  out  of  life  by  giving 
the  most  under  circumstances  in  which  maximum 
activity  can  be  developed  with  least  danger  to  so- 
ciety. Under  these  circumstances  an  institution 
should  not  be  considered  an  expense  to  the  commu- 
nity but  a  distinct  economic  advantage  making  the 
most  out  of  its  defective  members.  It  will  enable 
a  given  defective  who  perhaps  lived  at  zero  efficiency 
in  the  community  or  perhaps  worse,  being  positively 
destructive,  to  live  at  ten  or  fifteen  per  cent,  effi- 
ciency and  thus  serve  to  give  much  that  would  other- 
wise be  lost  to  the  social  group  as  a  whole.  In  the 
process  of  doing  this  the  immediate  burden  is  taken 
from  the  shoulders  of  the  few  and  redistributed, 
through  the  process  of  taxation,  to  the  shoulders  of 
the  many.  This  is  one  of  the  ways  in  which  society 
equalizes  its  burdens. 

In  addition  to  the  feeble-minded  who  will  natur- 


THE  FEEBLE-MINDED  189 

ally  gravitate  to  institution  care  there  will  of  neces- 
sity remain  a  large  number  variously  distributed  in 
the  community.  Of  those  who  come  to  form  part  of 
other  defective,  dependent  and  delinquent  classes 
more  will  be  said  in  the  next  chapter.  There  still 
remain  a  great  many  who  are  inadequately  dealt 
with  and  who  are  not  able  to  adequately  protect 
themselves.  The  British  Commission  which  was 
appointed  to  study  this  whole  subject  recommended, 
among  other  things,  that  the  feeble-minded  in  the 
community  be  adjudicated  as  such  and  thus  given 
the  legal  status  of  children.  By  so  doing  the  com- 
munity would  not  be  endangered  by  their  attempted 
adult  activities  and  the  feeble-minded  themselves 
would  have  the  legal  protection  which  their  status  as 
children  would  naturally  entitle  them  to.  For  ex- 
ample: The  law  provides  that  majority  is  attained 
at  twenty-one  years  of  age.  From  this  time  forth 
the  individual  is  entitled  to  exercise  the  full  rights, 
duties  and  privileges  of  citizenship,  voting  for  in- 
stance, and  ceases  to  be  entitled  to  protection  as 
a  minor.  From  what  has  already  been  said  about 
age  the  manifest  absurdity  of  this  legal  provision 
when  interpreted  solely  as  chronological  age  is  at 
once  apparent.  That  a  person  who,  because  he  has 
lived  twenty-one  years  should  be  entitled  to  all  the 
privileges  of  citizenship,  even  though  he  may  only 
have  the  mental  development  corresponding  to  a 
two  or  three  year  old  infant  or  even  a  nine  or  ten 
year  old  child,  is  a  state  of  affairs  which,  to  put  it 
mildly,  cannot  but  seriously  impair  the  efficiency  of 


190  MENTAL  HYGIENE 

the  social  machine  if  there  are  many  such,  seems  a 
self-evident  proposition.  Such  a  level  of  inefficiency 
tends  constantly  to  drag  the  whole  level  of  accom- 
plishment downward.  Then  again  the  rights  and 
privileges  of  citizenship  give  the  citizen  a  right  to 
buy  liquor  in  a  saloon  and  drink  it.  Those  who  are 
familiar  with  the  reactions  of  the  feeble-minded 
know  what  that  means.  They  are  naturally  not 
nearly  so  well  able  to  take  care  of  alcohol  as  the 
approximately  normal  individual  and  are,  therefore, 
much  more  prone  to  commit  outrages  of  various 
sorts  under  its  influence.  If  the  feeble-minded  had 
the  legal  status  of  children  in  the  community  every 
one  would  be  put  on  notice  of  that  fact,  and  to  sell 
liquor  to  a  feeble-minded  man,  even  though  he  were 
forty  years  of  age  (chronologically)  would  constitute 
identically  the  same  offence  as  to  sell  liquor  to  a 
child.  Such  a  way  of  handling  the  problem  would 
not  only  put  every  one  on  notice  but  would  foster 
.that  sort  of  understanding  of  the  feeble-minded 
problem  in  the  large  as  would  make  for  a  more  intel- 
ligent handling  all  along  the  line. 

With  these  methods  of  taking  care  of  the  feeble- 
minded situation  the  defective  individual,  instead  of 
being  sought  out  and  sterilized  would  tend,  only  by 
his  own  behaviour,  to  remove  himself  from  the  com- 
munity. Continuing  antisocial  tendencies  would 
call  forth  measures,  graduated  in  their  effectiveness 
to  exclude  from  the  herd,  to  meet  it.  First  an  ad- 
judication, then  institutional  segregation  so  that  the 
feeble-minded  person,  as  a  result  of  his  own  be- 


THE  FEEBLE-MINDED  191 

haviour,  might  be  said  to  naturally  bring  about  his 
own  segregation.  This  to  my  mind  would  seem  to 
be  the  best  program.  At  least  I  am  sure  it  is  the 
sort  of  program  which  can  be  brought  to  pass  and 
so  is  far  superior  to  those  which  it  does  not  now 
seem  can  be  made  effective  because  they  have  not 
that  sort  of  backing  in  the  minds  and  hearts  of  the 
people  which  makes  it  possible. 


CHAPTER  Vn 

MISCELLANEOUS   GROUPS 

In  the  three  previous  chapters  I  have  discussed  the 
three  great  groups  of  the  dependent,  defective,  and 
delinquent  classes,  namely,  the  insane,  the  criminal, 
and  the  feeble-minded  In  the  present  chapter  I  shall 
take  up  for  consideration  certain  other  groups, 
namely,  the  paupers,  prostitutes,  alcohol  and  drug 
addicts,  the  unemployed,  the  epileptic  and  show, 
among  other  things  that  those  who  go  to  make  up 
these  several  groups  might  all  be  classed  with  the 
three  groups  already  discussed  and  treated  as  such, 
or  in  certain  instances,  notably  the  epileptics,  be 
considered  as  sub-groups. 

THE   PAUPER 

We  are  inclined  to  look  upon  the  pauper  as  one 
who  has  been  unfortunate,  unlucky  in  life,  whose  fail- 
ure, in  other  words,  has  been  due  to  circumstances 
largely  outside  of  himself.  The  more  we  examine 
into  this  proposition,  especially  in  individual  in- 
stances, the  more  we  are  forced  to  conclude  that  it  is 
fundamentally  wrong  and  that  the  counter  proposi- 
tion *' Success  in  this  world  depends  upon  brains"  is 
very  much  nearer  the  truth. 

Let  us  take  an  extreme  example  to  illustrate  the 

192 


MISCELLANEOUS  GROUPS  193 

truth  of  the  above  position.     Suppose  that  a  man 
loses  his  arm  and  suppose,  in  addition,  that  his  posi- 
tion in  the  herd  happens  to  be  that  of  a  blacksmith  so 
that  his  arm  is  of  supreme  importance  to  him  and  its 
loss  prevents  him  from  plying  his  trade.     Suppose, 
as  a  result  of  that  loss,  that  he  goes  to  the  poorhouse. 
One  naturally  thinks  of  his  pauperism  as  dependent 
upon,  due  to  his  physical  injury.    But  after  all  is 
this   a  fair  conclusion?     Think  how  many  people 
there  are  who  have  lost  an  arm  or  a  leg,  or  both  legs, 
or  perhaps  their  eyesight  and  yet  were  able  to  get 
along  and  lead  efficient  lives  in  the  community!    I 
have  in  mind  a  man  who  completely  lost  his  eyesight 
in  his  twenties  as  the  result  of  an  accident,  yet  who 
lived  an  efficient  life  to  the  time  of  his  death  at  about 
sixty,  having  managed  to  raise  and  support  a  family 
and  give  his  children  college  educations.     And  then 
of  course  all  of  us  think  of  such  well  known  examples 
as  that  of  Miss  Helen  Keller,  a  young  woman  now, 
I  think  in  the  neighborhood  of  forty,  who  lost  abso- 
lutely both  her  eyesight  and  her  hearing  when  she 
was  about  three  years  old,  and  yet  she  is  not  only 
an  efficient  member  of  the  community  but  is  a  capable 
writer  and  speaker  and  very  much  beloved  by  every- 
body. 

With  such  facts  as  these  in  mind  it  becomes  neces- 
sary to  reconsider  the  proposition  that  the  pau- 
perism of  the  blacksmith  is  due  to  the  physical  loss  of 
his  arm.  It  would  seem  that  there  must  be  some- 
thing more  than  the  physical  injury  to  account  for 
such  a  complete  failure.     To  put  the  matter  broadly 


194  MENTAL  HYGIENE 

lie  has  failed  to  be  able  to  make  the  readjustment 
necessitated  by  his  injury  which  prevents  him  effec- 
tually from  following  his  trade  of  blacksmith.  What 
does  that  mean  if  not  a  mental  failure !  It  may  be 
expressed  by  saying  that  he  has  lost  his  nerve  or 
in  any  other  way,  but  the  essential  fact  is  that  he 
neither  has  the  mental  resiliency  or  resourcefulness, 
or  the  moral  courage  to  tackle  the  problem  of  life 
on  this  new  basis.  The  fact  that  he  may  be  too  old 
does  not  alter  the  explanation.  The  failure  is  a 
psychological  one.  If  he  had  had  the  mental  capac- 
ity he  would  not  have  had  to  go  to  the  poorhouse. 

Aside  from  the  fact  that  the  poorhouses  have  been 
caring  for  many  years  for  the  manifestly  insane  and 
feeble-minded,  it  must  be  evident  from  the  above  dis- 
cussion that  the  other  inmates  are  also,  though  per- 
haps not  so  patently,  mentally  inefficient — socially  in- 
adequate. Those  who  are  familiar  with  poorhouse 
types  will  be  able  to  recall  the  numerous  manifestly 
feeble-minded  and  otherwise  defective  types  which 
every  poorhouse  has  distributed  in  its  population 
and  will  perhaps  also  recall  the  numerous  instances 
of  individuals  who  are  able  to  live  in  the  community, 
after  a  fashion,  during  the  warm  months  of  summer 
but  seek  the  protection  of  the  poorhouse  when  the 
extreme  demands  of  cold  weather  are  ushered  in  with 
the  winter. 

In  addition  to  the  types  thus  far  referred  to  there 
will  be  found  in  every  poorhouse  a  considerable  num- 
ber of  aged  persons  more  or  less  blind  and  deaf  and 
in  a  number  of  instances  paralyzed  from  the  effects 


MISCELLANEOUS  GROUPS  195 

of  apoplectic  strokes  All  of  these  conditions  may 
of  course  be  thought  of  as  physical  conditions  which 
have  produced  the  pauperism,  and  in  a  sense  of 
course  they  are,  but  I  think  it  is  evident  that  the  ele- 
ment in  the  failure  which  is  most  important,  which 
in  fact  is  what  really  makes  the  failure  and  makes  a 
restitution  impossible,  is  the  mental  element  This  is 
not  generally  thought  to  be  so,  largely  at  least,  be- 
cause these  persons  appear  to  be  perfectly  ''sane"  as 
a  result  of  ordinary  observation.  I  think,  however, 
that  most  people  would  be  quite  astounded  to  see  the 
results  that  would  follow  from  a  systematic  mental 
examination  of  these  cases  and  learn  how  sadly  re- 
duced they  really  were.  The  outward  evidences  of 
a  sound  mind  can  be  maintained  for  a  long  time,  as  a 
sort  of  habit,  long  after  real  mental  capacity  has  fled. 
A  number  of  other  types  could  be  mentioned,  but 
the  same  reasoning  could  be  applied  to  all.  Pauper- 
ism is  a  problem  of  mental  inefjficiency  and  social  in- 
adequacy only  in  a  somewhat  less  obvious  and  cir- 
cumstantially different  setting  than  those  already 
considered. 

THE   PROSTITUTE 

Prostitution,  like  every  other  social  phenomenon, 
is  a  complex  product  and  therefore  dependent  upon 
many  causes.  That  a  large  number  of  prostitutes 
are  feeble-minded,  however,  is  no  longer  open  to 
doubt.  Easily  fifty  per  cent,  of  the  prostitutes  who 
come  within  the  sphere  of  observation  of  the  vari- 
ous police  agencies,  reformatories  and  homes  are 


196  MENTAL  HYGIENE 

feeble-minded.  Some  surveys  have  given  a  much 
higher  per  cent,  than  this  although  it  is  to  be  remem- 
bered that  probably  only  the  most  defective  *'get 
caught."  Fifty  per  cent.  I  am  convinced  is  a  con- 
servative estimate.  Yet  even  if  the  proportion  is  no 
higher,  feeble-mindedness  easily  constitutes  the  one 
most  important  cause  of  prostitution  and  the  one 
most  important  and  at  once  most  hopeful  aspect  to 
attack  with  remedial  measures. 

Probably  no  social  problem  has  been  attacked  with 
more  vigor  and  more  frequently  and  also  with  fewer 
desirable  results  than  the  problem  of  prostitution. 
The  history  of  prostitution  is  generously  sprinkled 
with  attempt  after  attempt,  each  one  useless  or  worse 
than  useless,  to  suppress  or  regulate  it.  The  funda- 
mental defects  in  all  these  attempts  have  been  two. 
In  the  first  place  prostitution,  in  just  the  same  way 
as  I  have  shown  with  reference  to  other  social  prob- 
lems, was  treated  as  a  unitary  concept,  that  is  as  a 
single  phenomenon  in  itself  and  not,  as  it  really  is,  a 
complex  of  all  manner  of  things.  In  the  second 
place,  the  effort  was  made  to  deal  with  it  solely  by 
repressive  measures.  The  repression  of  instincts, 
as  I  have  repeatedly  shown,  can  only  lead  to  some 
other  form  of  expression.  Eepression  alone  is  never 
the  true  solution  of  any  mental  problem.  If  a  cer- 
tain avenue  of  expression  is  cut  off  the  energy  has  to 
find  an  outlet  in  some  other  way,  therefore,  unless 
some  socially  useful  way  is  provided  or  ready  to 
hand  then  the  energy  will  break  through  in  some  un- 


MISCELLANEOUS  GROUPS  197 

desirable  form,  expression  will  be  obtained  in  a 
socially  undesirable  and  destructive  form. 

Perhaps  no  other  social  phenomenon  has  illus- 
trated better  than  prostitution  the  utter  uselessness 
of  trying  to  solve  it  by  means  of  methods  which  found 
their  ultimate  motivating  forces  in  the  hate  of  the 
herd.  What  this  means  I  have  already  indicated  in 
the  chapter  on  the  criminal  (Chap.  V).  Briefly,  of 
course,  it  means  that  this  particular  way  of  dealing 
with  the  sex  life  appeals  so  strongly  to  the  instinctive 
cravings  of  the  herd,  tends  so  strongly  to  unloose  all 
its  tendencies  which  make  for  letting  go,  backsliding, 
taking  the  easiest  way,  turning  aside  from  the  higher 
aims  of  culture  that  the  strongest  of  all  emotions  for 
fighting  purposes,  hate,  has  to  be  pressed  in  the 
service  against  it. 

As  I  have  indicated,  however,  real  lasting  gains  can 
not  be  obtained  by  means  of  actions  founding  in 
hate.  Hate  is  always  destructive,  it  never  builds 
permanent  and  enduring  structures.  The  prostitute 
for  centuries  has  been  shunned  as  sinful,  her  sin  irre- 
trievable, and  has  been  hunted  from  place  to  place 
by  the  officers  of  the  law  unremittingly  or  else  preyed 
upon  by  the  whole  hideous  pack  of  underworld 
grafters.  She  has  been  hunted  and  preyed  upon  but 
almost  never  considered  as  a  social  problem  worthy 
of  scientific  study  with  a  view  to  solution  until  today. 
Only  now  is  it  possible  to  see  through  the  thick  veil 
of  hate,  which  for  so  long  has  obscured  the  vision  of 
the  herd,  and  realize  that  the  problem  of  prostitution. 


198  MENTAL  HYGIENE 

like  the  other  social  problems  dealt  with  in  this  book, 
must  be  judicially  dealt  with  with  a  view,  not  of  vent- 
ing our  own,  individual,  personal  spleen,  but  seeing 
what  can  be  done  about  it.  And  too,  that  when  we 
come  to  attempt  the  solution  of  this  problem,  like  all 
the  others,  we  must  understand  that  no  solution  can 
issue  which  is  not  at  once,  to  some  extent  at  least,  a 
solution  for  both  factors  involved — the  individual 
and  the  community — in  order  to  help  one  we  must  be 
able  to  help  the  other.  Destroying  the  individual 
does  not  help  the  herd.  To  destroy  an  individual  is 
too  much  like  destroying  so  much  energy.  We  must 
try  and  see  if  it  is  not  possible  to  turn  the  energy  into 
more  useful  channels,  to  direct  it  to  better  ends,  to 
use  it  to  better  advantage. 

Without  doubt  the  most  important  single  factor  in 
the  prostitution  problem  is  the  factor  of  f eeble-mind- 
edness.  Feeble-mindedness  is  largely  responsible 
for  the  ease  with  which  the  prostitutes  can  be  traf- 
ficked in,  it  must  be  largely  at  the  basis  of  the  white 
slave  trade  although  of  course  not  wholly.  The  very 
fact  of  feeble-mindedness,  however,  makes  these 
women  peculiarly  the  prey  of  the  unscrupulous,  puts 
them  almost  wholly  at  their  mercy.  Feeble-minded- 
ness and  the  consequent  dependence  is  too  the  large 
element  in  many  of  the  crimes  which  are  associated 
with  prostitution,  the  prostitute  being  exploited  and 
used  by  the  more  intelligent,  forceful  and  experi- 
enced male  criminal.  Feeble-mindedness  is  also, 
probably,  an  important  factor  in  increasing  the  dan- 


MISCELLANEOUS  GROUPS  199 

ger  of  the  prostitute  as  a  distributor  of  venereal  in- 
fection. 

If  f eeble-mindedness  is  the  factor  wMch  makes  for 
so  much,  of  the  actual  danger  to  society  in  prostitu- 
tion it  is  also  the  most  hopeful  aspect  because  more 
capable  of  doing  something  practical  about.  As  it 
is  today,  for  the  most  part,  the  prostitute  is  simply 
treated  as  an  outlaw  and  when  caught,  that  is  ar- 
raigned for  some  technical  offence  (vagrancy,  solicit- 
ing), is  given  a  sentence  of  thirty  or  sixty  days  in  jail 
or  in  the  workhouse.  The  only  possible  good  that 
can  come  of  such  treatment  is  by  removing  a  carrier 
of  infection  from  the  community  for  a  given  period. 
But  even  so,  her  going  back  to  her  calling  is  not  con- 
ditioned upon  her  being  free  from  disease  but  upon 
the  expiration  of  the  arbitrary  time  limit  prescribed 
by  the  judge.  Aside  from  this  physical  removal 
from  the  community  for  a  given  period  what  possible 
good  can  such  treatment  do  to  either  the  prostitute 
herself  or  to  society?  How  can  it  be  conceived  to  as- 
sist at  all  in  the  solution  of  the  social  problem? 

The  fundamental  difficulty  is  again  that  the  of- 
fender, in  this  case  the  prostitute,  is  treated  for  some- 
thing which  they  are  not.  That  is,  just  as  in  the 
case  of  the  criminal,  the  offence,  in  the  abstract,  is 
dealt  with  by  society  proceeding  to  take  it  out  on  the 
particular  individual  who  happens  to  have  committed 
it.  To  treat  every  prostitute  in  this  way,  to  group 
them  all  under  the  single  classification,  and  then  to 
expect  one  single  form  of  treatment  to  be  effectual 


200  MENTAL  HYGIENE 

in  all  cases  is  as  ridiculous  as  to  expect  quinine  to  be 
the  remedy  for  all  fevers.  Such  a  viewpoint  can 
only  be  due  to  a  failure  to  study  the  individual  prob- 
lem. 

As  soon  as  the  individual  is  studied  we  will  find 
that  the  prostitute  class,  like  every  large  social  class, 
is  made  up  of  a  great  variety  of  types.  We  will 
find  all  sorts  of  mild,  incipient,  and  residual  mental 
disease,  all  sorts  of  physical  illness,  all  sorts  of 
stresses  at  the  social  level,  economic  particularly,  and 
finally,  and  most  important,  a  large  proportion  of 
feeble-mindedness.  Now  when  a  prostitute  is  ar- 
raigned for  some  offence  if  she  could  be  treated  for 
what  is  really  the  matter  with  her  the  first  great  step 
would  be  taken  in  the  rational  handling  of  this  great 
problem.  This  would  mean,  in  the  case  of  the  feeble- 
minded woman,  that,  instead  of  sending  her  to  jail 
or  the  workhouse  for  a  given,  usually  short,  period 
that  she  be  committed  as  feeble-minded  to  an  institu- 
tion. Here  she  would  cease  to  be  a  positive  source 
of  danger  to  the  community  (moral  and  physical) 
but  might,  as  a  result  of  education,  become  an  actual 
source  of  energy,  a  real  assistance  relatively  speak- 
ing. Here  she  would  be  kept  and  so  prevented  from 
spreading  disease  and  depravity  and  also  prevented 
from  reproducing.  If  circumstances  could  be  so  ar- 
ranged as  to  adequately  protect  the  situation  she 
might  be  paroled  with  a  view  to  discharge  if  her  con- 
duct and  efficiency  or  the  solicitous  oversight  of 
friends,  relatives  or  a  charitable  organization  war- 
ranted.   In  this  way  of  dealing  with  the  situation  the 


MISCELLANEOUS  GROUPS  201 

woman  is  dealt  with  for  what  she  is  rather  than  at- 
tempting to  deal  with  the  act  as  such  and  by  so  doing 
being  blinded  either  by  hate  or  a  sickly  sentimentality 
from  seeing  the  real  human  problem  and  therefore 
doing  the  really  constructive  thing  about  it. 

Those  who  are  not  feeble-minded  need  just  as  in- 
telligent treatment  for  the  particular  thing  that  ails 
them.  A  woman,  perhaps  defective  morally,  might 
be  driven  to  prostitution  to  earn  a  living  because  too 
ill  to  work,  who,  if  relieved  from  her  physical  illness 
would  gladly  give  up  prostitution.  And  similarly 
for  every  case.  Each  individual  would  need  indi- 
vidual treatment — the  principle  for  which  this  book 
stands. 

THE   INEBRIATE 

Inebriety,  like  the  other  conditions  I  have  dis- 
cussed, is  not  a  unitary  concept.  Persons  are  im- 
pelled to  drink  for  all  sorts  of  reasons  and  the  drink- 
ing is  only  the  outward  sign  of  what  is  going  wrong. 
Alcoholic  indulgence  may  be  an  indication  of  a  be- 
ginning psychotic  excitement  or,  on  the  other  hand, 
of  a  depression;  it  may  be  a  feature  of  the  early 
stages  of  a  dementia  precox  or  of  paresis ;  it  may  be 
a  periodic  affair  which  seems  to  affiliate  it  with  the 
epilepsies ;  it  may  be  the  final  desperation  of  one  who 
has  failed  utterly  or  who  is  suffering  from  a  hopeless 
illness.  The  persons  who  drink  may  be  highly  in- 
tellectual or  deeply  defective,  and  to  use  the  class 
terms  already  defined  may  be  insane,  criminal  or 
feeble-minded,  or  may  be  paupers,  prostitutes,  epi- 


202  MENTAL  HYGIENE 

leptics,  vagrants  or  what  not.  Aside  from  all  these 
complicating  conditions  there  are  a  group  of  inebri- 
ates as  such.  These,  while  not  alike,  by  any  means, 
any  more  than  any  other  group  of  people  are  made 
up  of  like  units,  have,  in  a  general  way  similar  rea- 
sons for  drinking,  although  in  each  individual  case 
the  reasons  are  given  a  special  turn  applicable  to 
that  particular  person  only. 

I  think  it  well,  before  proceeding  further  with  a 
discussion  of  the  inebriate,  to  first  mention  two  popu- 
lar delusions  concerning  alcohol. 

There  are  two  conceptions  connected  with  the  use 
of  alcohol,  one  of  which  has  been  seriously  invaded 
on  the  scientific  side  and  its  position  weakened,  but 
the  other  of  which  still  holds  sway.  The  first  of 
these  is  the  conception  that  alcohol  is  a  stimulant.  I 
need  hardly  tell  how  thoroughly  the  props  have  been 
knocked  out  from  under  this  position.  In  the  de- 
struction of  this,  I  might  almost  call  it  superstition, 
the  work  qf  Kraepelin  stands  out  prominently.  The 
other  is  the  idea  that  alcohol  is  a  habit-forming  drug. 
This  means,  I  take  it,  that  it  has  some  special  power 
for  creating  a  habit  on  the  part  of  the  individual  and, 
that  power  is  greater  for  some  reason,  not  specified, 
than  the  habit-creating  power  of  milk,  beefsteak,  or 
other  nutrient  taken  into  the  gastro-intestinal  tract. 
This  second  conception  is  still  strong  in  the  minds  of 
people  at  large,  and  I  think  occupies  a  place  in  a 
great  deal  of  the  thinking  of  professional  men  about 
alcoholism.  It  is,  however,  in  my  opinion,  as  faulty 
a  belief  as  the  belief  in  its  stimulating  properties; 


MISCELLANEOUS  GROUPS  203 

both  beliefs  are  founded  upon  the  same  cause,  the 
knowledge  of  which  serves  to  explain  them. 

It  is  unnecessary  to  enter  further  into  the  details 
of  the  experimental  work,  which  has  demonstrated 
that  alcohol  is  not  a  stimulant,  than  to  say,  that  in  a 
general  way  the  practical  results  of  that  work  are 
that  accurate  observations  of  both  muscular  and 
mental  work  under  the  influence  of  alcohol  show  a 
progressively  falling  curve  of  efficiency.  As  to  the 
matter  of  the  habit-forming  properties  of  alcohol,  I 
am  not  aware  that  any  experimental  work  has  been 
instituted  to  demonstrate  their  existence  or  lack  of 
existence. 

Inebriety,  as  the  term  is  here  used,  in  my  opinion, 
must  be  considered  as  a  neurosis,  and  from  this  point 
of  view  has  the  two  fundamental  traits  of  a  neurosis 
which  are  of  prime  importance  in  explaining  its 
symptoms  In  the  first  instance,  the  prevailing  and 
all  pervading  feeling  of  the  neurotic  is  one  of  ineffi- 
ciency, and  I  think  that  it  will  be  admitted  that  the 
life  history  of  the  alcoholic  shows  him  to  be  an  ineffi- 
cient individual.  He  is  incapable  of  meeting  reality 
efficiently  every  day.  He  may  be  able  to  deal  with 
the  problem  of  reality  for  a  greater  or  lesser  length 
of  time,  but  continuity  of  effort,  day  in  and  day  out, 
is  foreign  to  the  alcoholic  character.  He  can  stand 
the  strain  only  about  so  long,  longer  in  some  cases 
than  in  others,  but  the  principle  is  the  same.  This  is 
the  inefficiency  Adler  believes  is  dependent  upon  or- 
ganic inferiority,  or  to  use  an  older  and  more  tried 
term,  it  is  constitutional. 


204  MENTAL  HYGIENE 

Now,  assuming  this  condition  of  inefficiency,  based 
upon  constitutional  organic  defect,  in  the  make-up  of 
the  individual,  how  does  such  a  person  react  to  such  a 
deficiency  of  make-up?  The  reaction  is  an  effort  at 
finding  safety, — it  is  the  safety  motive,  the  instinct 
for  the  familiar,  the  flight  to  cover,  so  to  speak,  which 
drives  the  inefficient  individual  to  find  some  way  of 
escape  from  the  horrid  facts,  the  overburdening  op- 
pressions of  reality. 

This  path  he  finds  open  to  him  through  the  use  of 
alcohol.  How  frequently  do  we  see  the  alcoholic,  not 
going  out  among  people  and  meeting  with  his  fellows, 
not  mixing  with  the  world,  but  retiring  by  himself, 
shutting  himself  up  in  his  room,  perhaps  in  darkness, 
in  solitude,  and  in  quiet,  and  drinking  himself  stupid, 
unconscious!  Here  the  escape  is  absolutely  neces- 
sary, there  is  no  compromise  possible;  reality  must 
be  driven  out  at  any  cost,  even  to  the  point  of  uncon- 
sciousness. 

We  have  of  course  many  lesser  degrees  of  escape 
than  this.  We  have  the  jovial,  story-telling,  tipsy 
inebriate,  who  escapes  from  all  responsibility,  who 
sits  up  all  night  ^nd  slaps  his  friends  on  the  back, 
and  laughs  and  jokes,  and  gives  the  morrow  notice 
that  he  cares  not  what  it  brings  forth,  that  tonight  is 
tonight,  and  let  the  morrow  take  care  of  itself.  We 
know  the  type,  but  does  not  the  same  explanation 
hold  as  in  the  former  case?  Is  not  this  man  also 
escaping  from  reality  by  not  meeting  it  efficiently, 
not  only  by  so  crippling  himself  that  on  the  morrow 


MISCELLANEOUS  GROUPS  205 

he  is  unable  to  face  it,  but  by  Ms  very  words  he  ab- 
jures it? 

The  feeling  of  inefficiency  and  flight  from  reality, 
the  ear-marks  of  a  neurosis,  are  the  ear-marks  of  al- 
coholism and  now  we  can  understand  why  alcohol  has 
been  called  a  stimulant,  and  why  it  has  been  called 
a  habit-producing  drug.  It  has  been  called  a  stimu- 
lant, because  the  individual,  who  is  incapable  of  fac- 
ing reality  and  has  had  to  take  alcohol  to  escape,  has 
had  also  to  have  the  best  possible  reason  for  taking  it 
— namely,  that  it  would  help  him  to  meet  reality.  It 
is  a  pure  fiction  of  the  alcoholic,  this  stimulating 
property  of  alcohol.  As  to  the  habit-producing  qual- 
ities of  this  drug — another  fiction — the  alcoholic  can- 
not get  along  without  his  alcohol ;  he  must  find  a  road 
that  takes  him  away  from  reality,  once  in  a  while  at 
least ;  therefore  the  fiction  of  the  habit.  The  alcohol 
has  gripped  him  with  this  mysterious  habit ;  like  an 
evil  spirit  he  is  in  its  clutches,  and  therefore  he,  him- 
self, to  himself  is  no  longer  responsible.  He  has  pro- 
jected his  responsibility  upon  this  myth,  and  there- 
fore calmed  his  conscience. 

All  this  is  true,  too,  of  the  various  drug  addictions. 
The  fundamental  underlying  reason  for  the  indul- 
gence is  always  an  exquisitely  personal  one  and  so 
the  treatment  can  never  get  anywhere  that  lumps  all 
these  persons  together  and  deals  with  them  all  alike. 
Farm  colonies,  outdoor  work,  general  hygienic 
regime  are  all  very  well  in  their  way  and  have  much 
to  be  said  for  them  aside  from  any  alleged  therapeu- 


206  MENTAL  HYGIENE 

tic  advantages  which  they  may  have,  but  such  treat- 
ment can  never  offer  anything  more  than  a  tempo- 
rary respite  from  the  tyranny  of  the  neurosis. 

We  are  familiar,  however,  with  the  great  claims 
made  by  many  agencies,  particularly  by  those  of  a 
more  or  less  religious  character.  It  is  true  that  such 
agencies  often  succeed  when  all  other  means  have 
failed.  Their  success  is  dependent  upon  their  ability 
to  seize  upon  and  use  the  regressive  tendency  (dis- 
cussed in  Chap.  Ill)  in  a  socially  acceptable  and  use- 
ful way.  The  inebriates  come,  through  the  religious 
appeal,  to  renounce  their  self-sufficiency  which  has 
always  gotten  them  into  trouble,  and  as  little  chil- 
dren (regression)  accept  the  guidance  offered.  In 
this  way  regression  is  made  regenerative. 

Here  again  the  individual  should  be  treated  for 
what  he  is,  not  for  what  he  is  not.  No  good  can  come 
of  locking  him  up  for  a  few  days  in  the  workhouse. 
The  therapeutic  attack  must  be  by  way  of  the  psycho- 
therapeutic approach. 

THE  EPILEPTIC 

Just  as  we  have  seen  that  all  sorts  and  conditions 
of  people  are  included  under  each  of  the  groups  we 
have  discussed  thus  far,  so  it  is  true  of  epilepsy ;  the 
term  includes  all  sorts  of  conditions — epileptics 
include  all  sorts  of  persons.  It  makes  no  difference 
from  what  angle  we  approach  the  problem  of  epi- 
lepsy, from  that  of  cause,  pathology,  course  of  the 
disease,  methods  of  treatment  or  any  other,  we  shall 


MISCELLANEOUS  GROUPS  207 

find  tlie  problem  immensely  complex  and  shading  off 
on  all  sides  into  other  regions. 

The  term  epilepsy  itself  is  falling  into  disrepute 
because  it  no  longer  connotes  anything  at  all  definite. 
As  a  result  the  term  ^'the  epilepsies"  has  come  into 
use  only  in  its  turn  to  prove  too  vague  to  be  useful. 
This  class  of  disorders  might  be  said  to  belong  to 
the  group  of  convulsive  disorders  except  for  the  fact 
that  every  extreme  of  seizure  is  included  from  the 
mildest  and  most  transitory  disturbances  of  con- 
sciousness to  the  definite  convulsive  attacks  and  the 
long  periods  of  mental  disorder. 

Just,  however,  as  we  saw  in  dealing  with  the  ques- 
tion of  inebriety,  aside  from  all  the  various  compli- 
cating factors,  that  resort  to  certain  narcotizing 
drugs  represented  a  fairly  distinct  type  of  reaction, 
so  here  we  find  that  disturbances  of  consciousness  of 
the  general  nature  of  assumptions  of  less  clear  con- 
scious states  tending  to  unconsciousness  represent  a 
distinct  reaction  type. 

This  tendency  to  become  unconscious  is  explicable 
along  the  same  lines  as  those  followed  in  explaining 
inebriety.  Unconsciousness  is  a  flight  from  reality 
just  as  drunkenness  is  only  it  is  a  much  more  success- 
ful flight  and  so  represents  a  much  greater  necessity 
and  therefore  a  more  serious  lack  of  capacity  for 
adaptation.  Keeping  in  mind  the  immense  amount 
of  work  which  has  been  done  on  epilepsy,  particu- 
larly that  based  on  the  hypothesis  of  its  autotoxic 
origin,  still  I  am  sure  that  the  trend  of  the  best 


208  MENTAL  HYGIENE 

opinion  today  is  to  see  in  this  flight  from  reality  the 
essential  element  in  the  pathological  reaction.  Just 
as  in  the  phenomena  of  alcoholism,  so  here  too,  the 
particular  reason  in  each  individual  case  is  exquis- 
itely personal.  While  the  general  principle  of  the  re- 
action by  unconsciousness  is  that  it  is  a  flight  from 
reality,  nevertheless  the  reasons  which  make  such  a 
flight  necessary  are  different  with  each  individual. 
Treatment,  therefore,  which  is  other  than  individual 
can  hardly  be  expected  to  have  any  more  than  tem- 
porarily ameliorating  results. 

The  necessity  for  intensive  study  of  the  individual 
in  order  to  intelligently  handle  the  problem  he  pre- 
sents, in  order,  as  I  put  it,  to  treat  him  for  what  he  is 
and  not  for  what  he  is  not,  is  probably  nowhere  more 
obvious  than  here,  for  this  type  of  reaction  is  found 
in  widely  different  types  of  persons.  The  epileptic 
(so-called)  may  be  a  criminal,  a  pauper,  an  inebriate, 
a  prostitute,  insane,  or  feeble-minded,  young  or  old, 
sick  or  well  and  for  each  of  these  conditions  there 
must  be  a  different  angle  of  approach.  The  depend- 
ency of  these  attacks  upon  demonstrable  physical 
causes  may  be  great  (head  injury,  brain  tumor. 
Bright 's  disease)  or  negligible,  and  treatment  must 
vary  accordingly. 

THE   HOMOSEXUAL 

This  social  group,  like  the  others,  is  a  com- 
plex and  heterogeneous  one  and  one,  too,  that 
we  have  only  recently  come  to  study  scientifi- 
cally.   Perhaps  no  group  of  individuals  have  suf- 


MISCELLANEOUS  GROUPS  209 

fered  from  less  understanding,  have  been  treated 
with  greater  lack  of  consideration,  than  this 
group.  The  antipathic  emotions  have  held  almost 
complete  sway  and  so  have  made  the  scientific 
approach  to  the  problem  practically  impossible. 
The  history  of  society's  attitude  towards  the  homo- 
sexual is  much  the  same  as  the  history  of  its  attitude 
towards  the  prostitute  except  that  it  has,  if  possible, 
been  more  completely  dominated  by  the  antipathic 
emotions. 

Homosexuality  has  come  of  late  to  have  a  much 
broader  meaning  than  that  usually  connoted  by  the 
popular  speech.  It  means  that  degree  of  attraction 
for  the  same  sex  which  turns  the  individual  aside  on 
the  path  towards  a  heterosexual  goal  and  therefore 
away  from  those  activities  which  naturally  lead  to 
procreation  and  are  therefore  race-preservative. 
The  term  by  no  means  necessarily  connotes  actual 
concrete  acts  of  sexual  perversion.  In  this  large 
sense  it  is  readily  seen  why  it  should  be  tabooed  by 
the  herd.  Its  tendency  is  destructive  to  the  interests 
of  the  herd  as  a  biological  unit  and  therefore  the  re- 
action against  it.  The  reaction  of  hate  and  its  con- 
geners is  the  instinctive  way  of  self -protection  and 
must  necessarily  precede  any  judicial,  intelligent  at- 
titude based  upon  scientific  knowledge  which  can  only 
come  in  the  course  of  development  when  instinct  shall 
have  been  controlled  and  directed  by  reason. 

As  already  intimated,  the  homosexual  group  is  a 
large  and  complex  one  and  we  are  only  beginning  to 
be  able  to  approach  its  problems  with  a  clear  scientific 


210  MENTAL  HYGIENE 

vision,  but  as  we  are  able  to  do  this  we  come  more 
and  more  to  an  appreciation  of  how  widely  this  par- 
ticular type  of  inefficiency  is  distributed.  Again, 
therefore,  we  come  to  appreciate  the  emphasis  which 
I  have  all  along  put  upon  the  necessity  for  studying 
the  individual  in  order  that  he  may  be  dealt  with  for 
what  he  is  rather  than  perfunctorily  classified  with 
this  or  that  social  group  just  because,  and  for  no 
other  reason,  the  accident  of  circumstance  has  found 
him  momentarily  identified  with  it.  Distinct  homo- 
sexual types  are  found  among  the  insane,  the  crimi- 
nal, the  feeble-minded,  the  epileptic,  the  vagrant,  etc., 
etc.,  so  that  we  must  come  to  realize  that  it  is  a  type 
of  reaction,  not  a  label  to  distinguish  a  given  individ- 
ual from  all  others,  and  try  in  our  investigations  to 
evaluate  the  part  it  has  played  in  the  social  inade- 
quacy of  the  particular  individual  under  considera- 
tion. 

Viewed  in  this  way  it  becomes  a  problem  like  all 
the  others  and  the  objects  of  treatment  come  out 
clearly  instead  of  being  befogged  by  a  haze  of  emo- 
tion. 

The  homosexual  reaction  should  be  corrected  if 
possible.  Psychotherapy  is  the  most  hopeful  way  of 
approach.  Failing  this  the  individual  should  be 
taught  to  use  his  energies  as  best  he  can  based  upon 
an  understanding  of  himself.  The  ideal,  next  to 
cure,  would  be  a  direction  of  the  energies  into  socially 
useful  channels,  which  direction  would  at  the  same 
time  afford  an  adequate  fulfilment  of  the  individual. 

Homosexuality,  in  the  broad  sense  here  used,  is 


MISCELLANEOUS  GROUPS  211 

found  as  a  type  of  reaction  in  a  great  many  condi- 
tions which  constitute  or  lead  to  social  inadequacy. 
It,  therefore,  offers  a  natural  barrier  to  procreation 
of  the  socially  inadequate  classes  the  immense  value 
of  which,  to  the  herd,  has  not  been  appreciated.  It 
is,  so  to  speak,  a  natural  means  of  sterilization. 

THE   VAGEANT 

The  vagrant  class  is  a  large  one.  The  tramp  or 
the  hobo  as  he  is  called  is  an  international  institution, 
loosely  but  effectively  organized  for  its  purposes, 
having  a  paore  or  less  well  developed,  primitive  type 
of  language  of  its  own,  and  sig-ns  of  recognition  for 
kindred  spirits.  It  is  made  up  of  all  sorts  and  con- 
ditions of  men  and  as  a  social  level  of  reaction  corre- 
sponds roughly  to  the  prostitute  class. 

Individual  studies  will  show  that  this  class  is  made 
up  of  considerable  numbers  of  mild  or  aborted  psy- 
chotic types,  many  petty  criminals,  inebriates,  homo- 
sexuals, and  in  short  psychopathic  and  inferior  types 
of  character  of  every  sort. 

Here,  however,  as  in  other  cases  we  must  recognize 
vagrancy  as  a  particular  type  of  reaction,  though  of 
course  individually  conditioned  in  each  case.  It  is 
but  another  type  of  flight  from  reality.  Success  de- 
pends, among  other  things,  upon  industry  and  in- 
dustry means  doing  the  day's  work,  not  once  in  a 
while  but  every  day.  Success  is  built  upon  continu- 
ity of  effort  rather  than  upon  degree  of  effort.  The 
vagrant  belongs  to  the  type  of  individual,  like  the  in- 
ebriate, who  can  not  bring  himself  to  this  regularity 


212  MENTAL  HYGIENE 

of  expenditure  of  energy  in  a  given  direction,  he  con- 
stantly slips  from  under  his  responsibilities  and  finds 
in  vagrancy  a  permanent  way  out.  As  a  tramp  liv- 
ing from  day  to  day  on  what  he  can  beg,  with  no  ties 
that  bind,  no  home,  no  people,  no  fixed  abiding  place, 
he  feels  himself  free  from  all  the  restraints  civilized 
society  imposes  upon  its  responsible  members.  He 
sinks  to  a  level  of  reaction  which  does  not  make  de- 
mands upon  him  which  he  cannot  meet.  In  attempt- 
ing to  deal  with  the  vagrant  it  is  of  course  necessary 
to  know  the  individual  and  to  bear  in  mind  his  limita- 
tions trying  always  to  direct  his  energy  ijito  useful 
channels  at  highest  efficiency  at  his  level  of  capacity 
for  socially  adequate  reaction. 

THE   HOMELESS   UNEMPLOYED 

The  group  of  unemployed  that  can  be  found  in  the 
large  municipal  lodging  houses  offers  interesting 
problems  for  study.  Of  course  everything  imagin- 
able will  be  found  in  this  group.  There  will  be  found 
physical  disease  of  all  sorts:  tuberculosis,  valvular 
heart  disease,  chronic  disease  of  the  kidneys,  blind- 
ness, paralysis,  syphilis,  conditions  incident  to  age, 
senility,  various  types  of  mental  disease:  epilepsy, 
alcoholism,  imbecility,  relatively  defective  types  de- 
pendent upon  lack  of  education  or  lack  of  business 
training  or  training  in  a  skilled  trade ;  and  a  consid- 
erable number  will  be  found  at  certain  times  as  a  re- 
sult of  the  fluctuation  in  trade  conditions  which  oc- 
casionally throw  large  numbers  of  men  out  of  em- 
ployment at  short  notice. 


MISCELLANEOUS  GROUPS  213 

This  whole  group,  however,  impresses  the  investi- 
gator as  lacking  in  that  mental  alertness  which  is 
necessary  to  success  of  even  a  limited  degree.  A 
more  or  less  diseased  condition  of  some  organ  of  the 
body  is  not  an  adequate  explanation  for  failure.  Na- 
ture has  provided  us  with  very  much  more  of  every 
organ  than  we  need  for  any  ordinary  purpose.  If 
this  were  not  so  a  great  many  of  the  surgical  opera- 
tions which  are  done  every  day  in  our  hospitals  would 
be  quite  impossible.  When  we  bear  in  mind  such  re- 
markable examples  of  sick  men  as  Kant,  who  is  said 
never  to  have  left  his  home  town,  Konigsburgj  Her- 
bert Spencer,  who  for  years  was  able  to  work  only 
two  hours  daily,  and  Dr.  Harper  of  the  University  of 
Chicago,  who,  although  afflicted  with  a  deadly  disease 
and  suffering  great  pain  insisted  upon  working  to 
the  completion  of  a  task  he  had  in  hand  almost  up 
to  the  last  hour,  it  seems  almost  as  if  the  spirit  could 
surmount  every  obstacle  and  that  in  the  mind  was 
the  place  that  we  must  always  look  if  we  wish  finally 
to  know  the  true  explanation  of  any  man's  ineffi- 
ciency. 

To  be  sure  these  men  are  not  fair  average  exam- 
ples, they  are  the  extraordinary  exceptions.  Still,  a 
limited  experience  with  invalids  will  teach  one  the 
extent  to  which  the  psyche,  usually,  in  such  in- 
stances, referred  to  as  the  will,  is  capable  of  overcom- 
ing the  handicap  of  physical  illness. 

The  existence  of  all  these  groups  of  the  socially  in- 
adequate and  the  very  considerable  numbers  included 


214  MENTAL  HYGIENE 

in  each  (a  survey  of  London,  England,  indicated  that 
one  in  each  fifty  of  the  population  of  that  city  were 
dependent)  has  always  been  a  matter  for  the  alarmist 
and  pessimist  to  dilate  upon.  In  the  large  general 
view  which  I  have  tried  to  give  of  these  groups  I  have 
tried  to  show  what  their  existence  means.  In  fact, 
the  term  which  I  have  used,  socially  inadequate,  ex- 
presses that  meaning.  They  are  constituted  of  the 
people  who  fall  short  in  their  make-up  of  those  quali- 
ties which  make  it  possible  for  them  to  react  in  a  way 
which  is  satisfying  or  acceptable  to  the  standards  of 
the  society  of  which  they  form  a  part.  Viewed  in 
this  way  their  existence  has  a  decidedly  hopeful  and 
optimistic  aspect  for  it  means  that  society  is  strain- 
ing its  utmost  to  go  ahead  on  the  path  of  progress 
and  is  constantly  pushing  its  ideals  forward  just  as 
far  as  the  efficiency  of  its  constituent  elements  will 
permit.  How  much  better  off  we  are  with  all  these 
groups  of  the  inefficient  than  are  the  Oriental  socie- 
ties where  there  is  little  or  no  tendency  toward  the 
segregation,  natural  or  otherwise,  of  the  unfit  but  on 
the  contrary  where,  often,  their  reactions  are  erected 
into  a  something  desirable,  even  to  be  worshipped 
(the  Holy  men  of  India) .  The  inefficient  classes  fur- 
nish the  concrete  evidence  of  failure  to  attain  to  ac- 
cepted standards  of  efficiency  and  by  that  same  token 
bear  witness  to  the  height  of  those  standards.  Our 
intelligent  dealing  with  them  will  help  to  push  us 
forward  on  the  path  of  progress  rather  by  lightening 
the  load  than  by  blazing  the  trail. 


CHAPTER  Vin 

MISCELLANEOUS    PROBLEMS 

In  this  chapter  I  shall  briefly  discuss  a  number  of 
social  problems,  not  with  the  idea  of  settling  them  or 
even  of  setting  forth  my  own  viewpoint  regarding 
each,  but  solely  with  the  idea  of  indicating  certain 
attitudes  of  mind  which  interfere  with  their  adequate 
consideration.  In  this  way  I  shall  develop  certain 
general  principles  of  psychological  reaction  which  in- 
terfere with  efficiency  by  creating  psychic  scotomata 
(blind  spots)  and  so  justify  the  discussion  as  prop- 
erly belonging  in  a  work  on  the  principles  of  mental 
hygiene,  although  some  of  the  problems  discussed  do 
not  appear,  on  their  face,  to  have  any  near  relation- 
ship to  that  subject  matter. 

PATENT   MEDICINES — ^'CUEES'^ 

The  growth  of  various  sects  of  ^'healers"  has 
taken  place  in  response  to  a  demand  upon  the  part  of 
the  people.  They  have  come  into  existence  because 
of  a  need  which  a  large  number  of  people  have,  and 
they  are  the  answer  to  that  need.  That  need,  of 
course,  expressed  simply  is  the  need  for  better  health, 
but  if  we  will  confine  ourselves  more  particularly  to 
the  consideration  of  mental  cases,  it  is  a  need  for 
greater  happiness,  for  greater  peace  of  mind.    Be- 

215 


216  MENTAL  HYGIENE 

yond  that  the  need  need  not  be  more  specifically  ex- 
pressed. In  this  restless  civilization  of  ours  it  is 
pretty  difficult  to  find  a  place  where  one  may  feel  that 
he  has  attained  the  things  which  make  life  worth 
living  and  is  no  longer  assailed  by  cares  and  worries 
that  destroy  all  of  the  conditions  upon  which  peace 
of  mind  may  be  based.  The  restless  multitude,  seek- 
ing for  peace  of  mind — for  happiness,  for  fulfilment, 
— express  a  need,  and  so  along  comes  a  whole  host 
of  medical,  religious,  even  political  and  sociological 
sects  of  various  sorts  which  minister  to  this  cry  for 
help.  Some  people  get  comfort  out  of  religion ;  some 
people  get  comfort  out  of  associating  themselves  with 
various  charitable  or  reform  movements ;  fads  of  all 
varieties  and  in  every  sphere  of  life  grow  up,  and 
among  them  come  these  sects  of  healers  who  point 
out  to  the  dissatisfied — the  unhappy — that  their 
trouble  is  due  to  this  or  that,  that  it  is  dependent 
upon  some  physical  disorder,  perhaps  of  the  kidneys 
or  some  other  organ  of  the  body,  or  that  it  is  mental 
in  origin,  and,  therefore,  needs  some  kind  of  psycho- 
therapeutic treatment.  A  certain  portion  of  these 
unhappy  people  flock  to  the  standards  that  are  raised 
by  these  individuals  who  claim  to  know  what  the  mat- 
ter is  with  them  and  how  they  may  be  cured.  This 
attitude  is  perfectly  understandable.  It  is  not  only 
not  strange  that  it  is  so,  but  it  would,  indeed,  be 
strange  if  it  were  not  so.  The  chronic  invalid  will 
almost  surely  and  quite  naturally  take  the  advice  of 
a  man  who  says  confidently  ' '  I  can  cure  you. ' '  Who 
would  not  1    Would  not  you  or  I  if  we  had  been  pro- 


MISCELLANEOUS  PEOBLEMS  217 

nonnced  hopelessly  ill,  if  we  had  spent  years  in  fruit- 
lessly seeking  health  only  to  see  it  gradually  failing 
usf  Why  not  at  least  try? — it  can  do  no  harm,  and 
then  this  same  man  cured  Smith  and  Jones,  and  per- 
haps he  may  cure  me.  It  surely  is  worth  the  trial. 
This  argument  is  controlling  if  we  have  no  standards 
of  comparison  that  we  have  made  our  own  by  which 
we  may  judge  of  the  real  value  of  the  claims  set  forth. 
It  must  be  remembered,  too,  that  many  of  these  prac- 
titioners are  sincere  in  their  beliefs  and  really  think 
that  they  can  do  what  they  claim,  and  we  must  also 
not  forget  that  they  do  succeed  in  doing  what  they 
claim,  at  least  apparently,  in  a  sufficient  number  of 
cases  to  give  some  warrant  for  their  faith  in  them- 
selves and  for  others '  faith  in  them. 

If  we  will  look  over  the  history  of  these  cures  we 
will  find  that  almost  everything  which  the  imagina- 
tion can  conjure  up  has  been  used  to  cure  the  ills  of 
human  kind  and  that  almost  every  ill  that  can  be 
imagined  has  been  reported  cured  by  such  means. 
People  have  been  cured  of  most  everything  under 
the  sun,  by  little  pieces  of  metal,  by  bottles  of  medi- 
cine, by  salves,  by  electricity,  by  holding  on  to  iron 
rods  that  led  into  a  tub  of  bottles  and  water,  by 
hypnotism,  suggestion,  and  finally  by  religion,  and 
all  these  various  means  of  cure  have  cured  ills 
equally  various  and  have  all  cured  the  same  sort  of 
ills.  Now  the  first  principle  that  I  may  lay  down 
from  this  statement  is  that  whenever  we  find  a  cer- 
tain kind  of  illness  cured  by  various  and  divers 
means,  under  all  sorts  of  conditions  and  circum- 


218  MENTAL  HYGIENE 

stances,  we  may  feel  reasonably  certain  that  nothing 
in  the  agent  applied  has  really  had  anything  to  do 
with  the  recovery  of  the  patient ;  that  the  patient  not 
only  carried  within  himself  the  conditions  which 
made  him  sick,  but  he  also  possessed  within  himself 
the  powers  which  rightly  used  could  make  him  well, 
and  that  the  most  which  the  remedies  offered  could 
possibly  have  done  was  to  awaken  within  him  these 
powers  and  cause  him  to  put  them  to  use.  A  paraly- 
sis which  may  be  cured  indifferently,  either  by  a 
bottle  of  medicine,  the  application  of  a  magnet,  or  a 
prayer,  is  certainly  not  the  sort  of  paralysis  which 
is  dependent  upon  any  material  disorder  of  the  body 
that  we  know  of ;  certainly  not  the  kind  of  paralysis 
which  requires  for  its  amelioration  the  bringing  into 
contact  with  the  disordered  tissues  a  remedial  agent 
of  some  sort ;  certainly  it  is  quite  different  from  this, 
and  you  may  easily  understand  from  this  example 
why  it  is  that  I  say  that  the  patient  contains  not  only 
the  conditions  which  make  his  disease  possible,  but 
also  the  power  to  make  himself  well,  for  it  is  hardly 
conceivable  that  such  different  remedies  as  liquid 
medicine,  the  application  to  the  surface  of  a  magnet, 
and  prayer  could  have  some  common  quality  which 
was  responsible  for  the  result. 

It  is  this  class  of  cases,  which  I  have  illustrated  by 
the  patient  with  paralysis,  who  are  appealed  to  pri- 
marily by  all  sorts  of  alleged  cures,  and  it  is  this 
class  of  cases  that  frequently  make  an  apparently 
good  recovery  from  their  symptoms  under  the  treat- 
ment that  is  given;  it  matters  very  little  what  that 


MISCELLANEOUS  PROBLEMS  219 

treatment  is,  and,  therefore,  these  various  cnres  de- 
rive a  very  great  support  from  producing  such  re- 
sults, a  support  which  I  think  will  be  seen  from  my 
presentation  thus  far  is  entirely  an  ill-deserved  one, 
for  it  makes  the  claim  of  having  produced  a  result 
which  is  not  altogether  a  just  claim,  although  there 
is  a  certain  justice  in  it.  Without  attempting  to  ex- 
plain just  exactly  how  these  cures  are  effected  I  may 
say  that  in  such  a  case  of  paralysis  as  I  have  cited 
the  trouble  with  the  patient  is  that  he  thinks  he  is 
paralyzed,  and  when  he  can  be  made  to  think  that 
he  is  not  paralyzed  then  the  paralysis  disappears. 
This  disappearance  of  the  paralysis,  as  a  matter  of 
fact,  did  follow  the  treatment  and  was  in  some  way 
dependent  upon  that  treatment  and,  therefore,  there 
is  a  certain  justice  in  saying  that  the  practitioner 
whatever  his  method,  really  did  cure  the  patient. 
Herein  lies  the  abiding  fallacy  of  the  whole  situation 
and  the  one  particularly  to  which  I  desire  to  direct 
attention. 

Truth  is  evasive ;  perhaps  we  never  can  attain  to 
absolute  truth  with  regard  to  any  special  problem. 
Perhaps  the  best  that  we  can  do  is  to  keep  striving, 
and  by  striving  to  come  always  nearer  and  nearer, 
though  we  never  quite  attain.  And  so  we  have  to 
measure  the  claims  of  the  class  of  people  of  whom  I 
am  talking  against  the  claims  of  others  with  a  view 
to  seeing  which  of  the  several  claimants  most  nearly 
approximates  the  truth.  Now  it  is  true  that  a  cer- 
tain patient  with  a  certain  type  of  paralysis  goes  to 
one  of  these  healers,  submits  to  his  treatment,  and 


220  MENTAL  HYGIENE 

following  the  treatment  the  paralysis  disappears. 
That  happens  over  and  over  again,  and  the  healer 
says,  with  some  considerable  reason,  that  he  is  cured 
of  paralysis.  But  we  must  not  stop  there.  The 
healers  treat  all  cases  alike.  Their  classification  is 
more  primitive.  Paralysis  is  paralysis.  While  in 
medicine  we  know  that  there  are  very  many  forms  of 
paralysis;  from  injury  to  a  peripheral  nerve  (by 
trauma  or  toxin),  injury  to  the  spinal  cord,  injury 
to  the  bram  (from  many  causes  and  in  many  loca- 
tions), the  purely  psychogenic  type  without  discover- 
able physical  organic  lesion,  and  these  larger  group- 
ings could  be  subdivided  and  subdivided  in  ever 
smaller  groups.  Scientific  knowledge  advances  by 
seeing  differences  where  before  there  was  only  like- 
ness. The  healer's  knowledge,  from  this  point  of 
view,  is  therefore  much  more  primitive  and  so  his 
ability  to  adjust  his  treatment  to  each  individual  case 
much  less,  and  therefore  he  must  of  necessity  be  much 
less  competent  to  handle  the  problem  in  the  large 
despite  his  success  in  individual  instances. 

Then  again,  the  type  of  reasoning  which  concludes 
that,  because  in  a  certain  person  the  symptoms  of  his 
illness  disappeared  after  the  application  of  a  certain 
remedy ;  that,  therefore,  that  particular  remedy  was 
the  cause  of  their  disappearance,  is  most  dangerous, 
because  most  logical.  The  conclusion  is  one  of  those 
pitfalls  of  the  obvious  to  which  we  are  all  liable  in 
proportion  to  the  superficiality  of  our  knowledge. 
It  is  the  same  kind  of  reasoning  that  led  primitive 
man  to  believe  that  he  could  make  rain  by  going 


MISCELLANEOUS  PROBLEMS  221 

through  certain  ceremonies.  These  ceremonies  vary 
greatly,  but  for  the  most  part  consist  of  imitating  a 
storm  and  sprinkling  water  on  the  ground.  After 
they  have  been  carefully  performed  in  all  details 
then  it  rains — sooner  or  later — and  the  rain  is  as- 
sumed to  be  the  result  of  the  ceremonial.  It  is  the 
confusing  of  sequence  with  effect  and  is  one  of  the 
most  prolific  sources  of  error  and  of  groundless  su- 
perstitions and  theories.  The  rain  comes  following 
the  ceremonial  of  the  rainmaker,  but  is  the  result  of 
natural  causes  over  which  he  has  no  control  what- 
ever. Many  of  the  reputed  ' '  cures ' '  also  come  about 
following  certain  forms  of  treatment — also  as  a  re- 
sult of  natural  causes,  over  which  the  individual  ap- 
plying the  remedy  has  no  more  control  than  the  rain- 
maker. 

It,  therefore,  follows  that  no  one  should  be  per- 
mitted to  practice  the  art  of  healing  except  he  be 
grounded  in  the  structure  and  functions  of  the  human 
body  and  the  application  of  all  varieties  of  remedial 
agents  at  all  levels,  and  it  is  the  function  of  the  state 
to  see  that  the  people  who  are  accredited  by  it  to 
practice  the  art  be  so  equipped. 

The  whole  subject  of  medical  education,  the  equip- 
ment of  the  individual  to  practice  medicine,  is  a  com- 
plex one,  and  very  naturally  the  claims  of  medicine 
as  applied  to  the  lower  levels — to  the  physical  and  the 
physiological — have  received  attention  long  before 
the  claims  of  medicine  to  be  applied  at  the  psychologi- 
cal level.  The  psychological  level  is  the  last  level  to 
come  within  the  ken  of  the  physician  because  it  is 


222  MENTAL  HYGIENE 

the  most  complex  and  the  most  difficult  to  confront 
and  requires  a  great  deal  of  knowledge  about  the 
lower  levels  before  it  can  be  approached  at  all. 
Therefore,  it  has  remained  the  stronghold  of  the 
charlatans  and  the  faith  curists.  Even  the  most  ele- 
mentary instruction  is  not  given  today  in  many  of 
our  medical  colleges  regarding  the  disorders  at  the 
psychological  level,  and  the  general  result  is  that 
these  different  faith  curists  prosper,  and  the  physi- 
cian, knowing  deep  down  within  himself  that  the 
whole  business  is  nonsense  but  having  no  adequate 
education  in  such  matters  so  that  he  can  define 
wherein  the  nonsense  exists,  is  compelled  to  defend 
himself  against  them  by  attempting  to  cast  ridicule 
upon  their  methods,  and  if  approached  for  an  ex- 
planation of  what  the  trouble  is  he  is  pretty  apt  to 
be  so  weak  in  his  replies  as  to  help  the  cause  of  the 
opposition  more  than  to  hurt  it.  The  cry  of  the  men- 
tally afflicted  has  brought  the  inadequate  response  of 
the  'charlatan,  and  it  is  because  the  cry  is  unintelli- 
gent that  the  answer  is  inadequate. 

In  the  last  few  years,  however,  there  has  been  a 
noticeable  change  in  the  whole  matter  of  medical  edu- 
cation. The  Carnegie  Foundation  and  the  American 
Medical  Association  have  been  making  such  surveys 
of  the  medical  colleges  as  have  resulted  in  their  be- 
ing grouped  into  various  classes  according  to  the  ex- 
cellence of  the  instruction  given.  Such  a  public 
pointing  out  of  the  class  to  which  a  medical  college 
belongs  has  deflected  many  students  from  the  cheaper 
colleges,  where  medical  education  was  at  its  lowest 


MISCELLANEOUS  PROBLEMS  223 

ebb,  and  resulted  in  the  closing  of  these  colleges  be- 
cause of  lack  of  income  and  a  resulting  lessening  in 
the  number  of  medical  students  throughout  the 
United  States.  The  situation  now  is  that  no  person 
can  blindly  go  to  a  medical  school  without  knowing 
just  where  that  medical  school  stands  in  degree  of 
the  excellence  of  its  educational  facilities,  and  no  in- 
dividual who  employs  a  physician  need  lack  that 
knowledge.  Therefore,  a  great  step  has  already 
been  taken  in  advance  in  the  better  equipping  of  the 
man  who  is  to  practise  medicine  in  the  community. 
Now,  on  the  other  hand,  it  remains  for  the  public 
themselves  to  make  greater  demands  upon  the  physi- 
cian, and  not  only  maintain  the  standard  which  has 
been  reached  thus  far,  but  create  a  still  higher  one. 
In  the  matter  of  the  ills  of  the  mind,  physicians  to- 
day are,  on  the  whole,  quite  unable  to  cope  with  the 
problems  involved.  Practicaly  none  of  the  older 
physicians  have  ever  had  courses  in  their  medical 
training  that  dealt  with  mental  disorders,  and  very 
few  of  the  younger  practitioners  have  ever  had  any- 
thing that  remotely  resembles  an  adequate  course 
of  instruction.  Therefore,  the  physicians,  them- 
selves unable  to  meet  these  conditions,  are  indirectly 
one  of  the  greatest  sources  of  revenue  of  the  char- 
latan. The  charlatan  gets  what  the  physician  can- 
not deal  with.  It  becomes,  therefore,  the  duty  of  the 
physician  to  equip  himself  to  handle  these  conditions 
rather  than  to  bewail  the  fact  that  his  patients  go 
elsewhere,  and  he  will  equip  himself  and  he  will  be 
able  to  handle  them  when  the  public  makes  an  intelli- 


224  MENTAL  HYGIENE 

gent  demand  upon  him  for  that  class  of  service. 

I  have  not  undertaken  to  deal  with  distinct  frauds. 
There  are  many  claims  by  all  sorts  of  persons  to 
cure  disease  that  are  plainly  and  simply  fraudulent 
and  require  treatment  from  that  standpoint  by  the 
machinery  of  the  criminal  law.  It  makes  little  dif- 
ference to  the  patient,  however,  whether  the  claims 
are  fraudulent  or  sincere  so  long  as  the  result  is  the 
same  in  either  case.  I  have  merely  tried  to  point  out 
come  of  the  fallacious  methods  of  reasoning  that 
make  it  possible  for  either  or  both  to  make  a  suc- 
cessful appeal.  Ignorance  is  the  soil  in  which  all 
such  claims  prosper. 

In  this  example  is  seen,  perhaps  as  well  as  any- 
where, the  influence  of  ignorance  as  a  distorting  and 
destructive  factor  in  conduct.  But  it  must  not  be 
lost  sight  of  that  ignorance  is  a  relative  term.  A 
man  may  know  a  great  deal  about  something  and  be 
very  ignorant  about  something  else.  There  is  a 
saying,  which  emphasizes  this  aspect  of  ignorance, 
that  the  place  to  sell  a  gold  brick  is  on  a  college  cam- 
pus. In  that  realm  of  conduct  where  ignorance 
rules,  prejudice,  that  is  opinions  controlled  by  uncon- 
scious motives,  rules,  for  it  is  very  rare  to  find  a  per- 
son so  broadly  founded  as  not  to  be  susceptible  from 
this  angle  in  regions  of  knowledge  where  he  is  not 
familiar.  And  even  such  a  broad  gauged  person  is 
after  all  pretty  helpless  in  a  specific  concrete  matter 
about  which  his  experience  has  nothing  to  offer.  In 
a  given  condition,  for  example,  is  it  the  proper  thing 
to  operate?  and  should  the  operation  be  done  now 


MISCELLANEOUS  PROBLEMS  225 

or  ought  there  be  a  little  further  delay?  He  has  to 
hand  over  the  decision  to  someone  else,  the  best  he 
can  do  is  to  choose  with  all  the  keenness  of  vision  of 
which  he  is  capable  who  that  someone  else  shall  be. 

FATIGUE 

In  speaking  of  fatigue,  we  are  still  using  a  term  of 
very  vague  connotations,  and  dealing  with  a  condi- 
tion that  admits  of  measurement  only  with  the  great- 
est of  difficulty.  Not  only  this,  but  in  the  present 
state  of  our  knowledge,  it  is  practically  impossible 
to  state  wherein  the  fatigue  is  resident,  what  part 
of  the  individual  really  is  fatigued,  and  what  are 
the  mechanisms,  chemical,  physical  and  psychic,  of 
that  fatigue.  The  general  gross  fact  which  seems  to 
issue  from  this  complex  situation  is  that  human  be- 
ings, worked  under  given  conditions,  tend  to  show  a 
gradual  falling  off  in  the  efficiency  of  their  work,  and 
that  this  falling  off  in  efficiency  can  be  prevented  by 
changing  the  conditions,  more  particularly,  by  in- 
creasing the  opportunities  for  rest,  and  that,  fur- 
ther, when  human  beings  continue  to  work  under 
conditions  which  show  a  gradual  falling  off  in  effi- 
ciency, other  manifestations  tend  to  come  into  evi- 
dence, namely,  various  kinds  and  descriptions  of  dis- 
turbances of  health.  So  that,  with  our  present 
knowledge,  it  would  seem  more  accurate,  and  per- 
haps wiser,  to  deal  with  the  human  being  as  if  he 
were  a  machine,  and  with  his  efficiency  as  measured 
by  his  output,  and  endeavour  to  find  what  the  condi- 
tions are  which  lower  his  efficiency,  either  impairing 


226  MENTAL  HYGIENE 

it  temporarily,  or  tending  to  impair  it  permanently, 
and  then  endeavouring  to  discover  what  the  condi- 
tions are  which  will  prevent  this  temporary  or  per- 
manent impairment,  and  so  increase  the  efficiency. 

I  have  been  tempted  to  say  what  I  have  said,  which 
is  more  particularly  a  plea  for  greater  definiteness 
in  the  use  of  terms,  by  looking  through  the  literature 
of  fatigue,  particularly  in  connection  with  various 
occupations,  and  noticing  with  what  little  regard 
for  accuracy  the  term  fatigue  and  certain  other  terms 
were  used.  I  refer  more  particularly  to  the  condi- 
tions which  are  presumed  to  be  the  results  of 
mental  fatigue.  I  find  numerous  papers,  some  of 
them  by  well-known  men,  showing  the  prevalence  and 
the  increase,  particularly  of  neurasthenia  and  hys- 
teria, in  certain  occupations,  and  I  note  the  statistics, 
particularly  those  of  foreign  sanitaria,  for  the  work- 
ing classes,  showing  the  immense  increase  in  nervous 
diseases  that  have  been  admitted  to  these  sanitaria 
in  recent  years.  There  appears  to  be  very  little  in 
any  of  this  literature  that  at  all  adequately  accounts 
for  these  conditions. 

In  the  realm  of  the  neuroses  and  the  psychoneu- 
roses,  such,  particularly,  as  neurasthenia  and  hys- 
teria, the  particular  character  of  the  work,  or  its 
severity,  could  by  no  possibility  operate,  if  our  pres- 
ent ideas  of  these  conditions  are  correct,  as  adequate 
causes.  Hysteria,  for  example,  is  a  purely  mental 
disease,  dependent  upon  purely  mental  causes;  in 
other  words,  psychogenic  in  origin.  Work  of  any 
character  or  description,  or  of  any  degree  of  sever- 


MISCELLANEOUS  PROBLEMS  227 

ity,  could  not  be  conceived  to  be  a  cause  in  any  true 
sense.  We  all  know  that  if  we  have  some  weak  point 
in  our  bodies  that  it  bothers  us  more  when  we  are  be- 
low par,  and  we  are  able  to  adjust  to  it  better  when 
we  are  in  good  health.  The  muscles  of  accommoda- 
tion, for  example,  partake  of  the  tone  of  the  general 
musculature,  and  when  health  is  good  they  may  give 
little  trouble,  but  when  the  health  is  poor  they  may 
make  difficulty.  In  the  same  way,  and  only  in  that 
way,  can  occupations  or  fatigue  of  any  kind  be  said 
to  be  a  causative  factor  of  hysteria.  They  can  only 
be  adjuvant  causes  at  best,  and,  at  that,  as  will  be 
seen,  unimportant  ones. 

With  neurasthenia  we  are  dealing  with  a  condition 
which  is  not  so  prominently  mental.  In  fact,  neuras- 
thenia, as  we  understand  it  today,  is  not  a  mental 
disorder  primarily,  but  a  physical  disorder.  How- 
ever, the  term  ''neurasthenia"  is  perhaps  one  of  the 
most  loosely  used  terms  in  medicine,  and,  as  I  see 
it  through  the  literature  that  I  have  spoken  of  be- 
fore, there  appears  to  be  no  definiteness  about  its 
use.  It  is  applied  to  all  sorts  and  conditions  of 
things,  including  the  whole  realm  of  the  neuroses 
and  the  psychoneuroses,  and  probably  some  of  the 
actual  psychoses.  Now  we  have  a  fairly  well-defined 
syndrome  to  which  the  term  neurasthenia  is  applica- 
ble, the  symptoms  of  which  are,  in  the  main,  a  feel- 
ing of  pressure  on  the  top  of  the  head,  more  or  less 
insomnia,  spinal  irritation,  with  perhaps  pain  in  the 
back,  certain  paresthesias,  easy  fatiguibility,  and 
emotional  irritability.     This  may  be  a  primary  neu- 


228  MENTAL  HYGIENE 

rosis  or  it  may  be  a  secondary  neurosis  following 
upon  other  illnesses,  such  as  prolonged  sickness  of 
some  kind,  or  following  an  acute  illness,  such  as 
typhoid  fever.  As  a  primary  neurosis,  it  may  be  de- 
scribed as  a  primary  fatigue  neurosis,  although  it 
must  be  realized  that  the  belief  that  it  is  due  to 
fatigue,  and  that  the  symptoms  are  dependent  upon 
the  elaboration  of  toxic  fatigue  substances,  is  purely 
hypothetical.  Even  admitting  the  truth  of  all  these 
things,  however,  there  is  absolutely  no  warrant,  if 
our  present  concepts  of  this  condition  are  correct, 
and  they  are  being  verified  every  day,  for  believing 
that  occupations  of  any  kind,  or  of  any  degree  of 
severity,  can  be  other  than  purely  adjuvant  and  un- 
important causes  of  this  condition  as  in  hysteria. 

We  see  in  the  literature,  for  example,  that  a  great 
many  of  the  telephone  girls  are  getting  neurasthenia 
and  the  cause  is  attributed  to  long  hours  of  work, 
the  extreme  effort  of  attention  that  is  necessary  be- 
cause of  the  character  of  the  work,  and  its  constant 
annoyance  and  irritating  character.  All  of  these 
things  are  true,  but  if  the  modern  hypothesis  of  neu- 
rasthenia, to  which  I  have  referred,  is  correct  they 
can  not  be  the  fundamental  causes.  To  speak 
broadly,  we  can  only  understand  the  neurasthenia  in 
such  cases  by  thinking  of  these  girls  as  individuals 
who  have  been  prepared  by  nature,  up  to  a  certain 
point,  to  fulfil  a  certain  function  and  then,  because 
of  the  exigencies  of  life  or  what  not,  all  of  the  ener- 
gies which  have  been  developed  in  that  direction  are, 
so  to  speak,  sidetracked  and  at  about  the  period  of 


MISCELLANEOUS  PKOBLEMS  229 

puberty,  when  nature  might  expect  physiological  and 
psychological  fulfilment,  the  individual  is  called 
upon  to  make  a  complete  readjustment,  to  find  en- 
tirely new  avenues  of  outlet  of  nervous  energy,  to 
concentrate  upon  entirely  alien  interests.  Now  some 
people  are  so  constituted  that  they  can  do  this  thing, 
so  they  succeed.  Others  are  so  constituted  that  they 
can  not.  They  become  neurasthenic  or  develop  other 
neuroses,  while  certain  others,  and  they  are  perhaps 
the  most  frequent,  occupy  a  borderland  position. 
These  girls,  under  favourable  conditions  of  employ- 
ment, with  plenty  of  opportunity  for  rest,  good  food, 
good  housing,  and  all  that  sort  of  thing,  manage  to 
get  along.  With  prolonged  hours  of  work  and  irri- 
tating conditions,  perhaps  coupled  with  unhygienic 
and  insanitary  living,  they  break  down.  So  it  will  be 
seen  what  I  mean  by  fundamental  causes  and  how  I 
regard  the  usually  attributed  causes  as  only  adju- 
vant. It  will  be  seen  also  why  I  believe  the  problem 
is  deeper  than  the  individual  and  strikes  at  once  at 
the  social  conditions  brought  about  by  the  various  in- 
dustries and  occupations. 

I  might  speak  of  other  conditions,  but  these  two 
are  sufficiently  illustrative.  Hysteria  surely,  and  in 
all  probability  neurasthenia,  belong  to  the  class  of 
diseases  which  are  not  dependent  upon  the  introduc- 
tion or  the  action  upon  the  body  of  some  specific  mor- 
bific agent.  They  are  essentially  social  diseases 
which  depend  for  their  existence  upon  the  malad- 
justment of  the  individual  to  his  social  surroundings, 
his  inability  to  fit  into  the  demands  that  are  made 


230  MENTAL  HYGIENE 

upon  him  because  of  his  relations  to  other  people, 
actually  or  prospectively,  and  as  such  can  not  be  de- 
pendent for  their  existence  upon  long  hours  of  work 
or  upon  the  character  of  that  work.  These  consid- 
erations, however,  do  not  make  it  any  the  less  im- 
portant that  they  be  considered  in  connection  with 
the  various  industries,  nor  does  it  make  it  obvious 
why  there  has  been  such  an  increase  in  the  number  of 
these  diseases.  A  moment's  reflection,  however,  I 
think  will  be  convincing  if  my  premises  are  accepted 
that  their  importance  lies,  not  in  the  fact  of  their 
association  with  any  particular  kind  or  character  of 
work  so  far  as  the  fatiguing  qualities  of  that  work 
may  be  concerned,  but  that  they  are  expressions  of 
causes  that  are  much  more  widely  operative,  social 
causes  which  have  invaded  and  changed  the  social 
conditions  under  which  the  people  live,  and  evidently 
changed  those  conditions  disadvantageously  so  as 
to  make  possible  the  outcrop  of  these  diseases.  The 
investigators  of  industrial  conditions  should  realize 
this  factor  in  the  situation  as  exemplified  by  the 
presence  of  this  class  of  diseases. 

My  plea,  then,  is  for  the  recognition  of  what  I  have 
termed  "social  diseases,"  for  a  realization  that  the 
problem  of  the  various  industries,  as  that  problem 
deals  with  the  question  of  the  health  of  the  workers, 
is  a  broader  problem  than  the  problem  of  ordinary 
physical  disease.  It  is  a  problem  which  touches  the 
whole  question  of  society,  and  which  presents  for 
consideration  the  neuroses  and  the  psychoneuroses 
as  indications  of  diseases  which  is  not  individual. 


MISCELLANEOUS  PROBLEMS  231 

but  sociaL  Here  we  have  in  this  class  of  diseases  a 
point  of  attack  upon  abnormal  social  conditions,  and, 
by  their  study,  some  kind  of  idea  may  be  had  as  to 
the  best  means  of  approaching  the  faulty  social  con- 
ditions of  which  they  are  the  expression,  and  which 
may  be  incident  to  the  industrial  conditions  under 
consideration. 

In  this  group  of  fatigue  reactions  we  haye  illustra- 
tions of  a  mechanism  for  dealing  with  a  severe  bio- 
logical maladaptation  by  developing  first :  a  psycho- 
logical defence  reaction  which  hides  from  the  suf- 
ferer the  real  cause  of  the  trouble,  so  often  remov- 
able, and  drives  them  on  to  further  efforts  along  the 
line  of  necessity,  and  second :  a  very  decided  tendency 
to  express  the  psychological  difficulty  in  terms  of  bod- 
ily illness  which  is  the  characteristic  of  the  hysterical 
reaction  and  is  known  as  the  mechanism  of  conver- 
sion. This  is  the  mechanism  so  often  in  evidence  to 
help  the  individual  to  refrain  from  doing  something 
they  do  not  wish  to  do.  Headaches  and  fatigue  are 
widely  used  for  this  purpose.  The  fatigue  of  the 
idle  classes  is  really  lack  of  interest,  ennui,  tedium 
vitas  in  persons  who  have  nothing  in  their  lives  that 
compel  them,  who  are  not  going  anywhere  in  par- 
ticular with  their  living.  Such  symptoms  disappear 
as  if  by  magic  as  soon  as  a  call  comes  to  do  some- 
thing the  individual  wishes  to  do. 

DIVOECE 

As  soon  as  we  touch  upon  the  sex  relations  we  in- 
stantly find  ourselves  in  a  haze  of  emotion  which 


232  MENTAL  HYGIENE 

makes  it  almost  humanly  impossible  to  discern  clear 
outlines.  Marriage  is  man's  effort  to  solve  the 
sexual  question,  and  in  the  solution  has  come  to  em- 
body his  highest  aspiration,  his  most  earnest  efforts 
toward  better  things.  Its  history  has  been  one  long 
course  of  trial  and  error  filled  with  the  tragedies 
which  blinding  emotions  have  brought  about.  Now 
that  monogamous  marriage  has  come  to  be  felt  as  a 
final  stage  in  the  large  evolutional  series  of  efforts 
the  question  of  whether  it  shall  be  permanent  or  not 
has  arisen,  and  if  it  may  be  dissolved  then  the  ques- 
tion is,  upon  what  grounds? 

The  controversy  which  has  been  waged  about  the 
divorce  question  has  been  a  bitter  one.  I  shall  only 
point  to  one  or  two  elements  in  it  which  show  the 
lack  of  ability  to  grasp  the  psychological  factors. 

Progress  takes  place  only  by  the  expenditure  of 
tremendous  amounts  of  energy  for  every  step  gained 
and  the  old  forms  tend  to  be  retained  indefinitely 
even  when  the  new  customs  make  their  meaning  no 
longer  evident.  Words  and  customs  signify  this  on 
all  sides.  We  use  the  word  palladium  to  mean  a  safe- 
guard for  something  precious  because  the  statue  of 
Pallas  was  supposed  to  safeguard  the  city  of  Troy; 
we  throw  rice  (seed)  after  a  married  couple  sup- 
posedly for  luck  but  with  the  deeper  meaning  to  in- 
sure their  fruitfulness ;  we  light  bonfires  on  all  great 
occasions  oblivious  that  we  are  employing  an  ancient 
symbol  of  purification,  etc.,  etc.  So  in  marriage  there 
still  remain  elements  in  the  ceremonial  which  hark 
back  to  the  old  practice  of  wife-capture,  and  mar- 


MISCELLANEOUS  PROBLEMS  233 

riage  is  still  a  means  for  legally  subordinating  the 
woman,  in  some  instances  to  the  level  of  a  chattel. 
Like  all  customs  it  tends  to  stay  in  the  region  of  the 
familiar,  it  is  smitten  with  the  plague  of  apathy. 
It  will  take  a  long  time  to  develop  the  possibilities 
of  a  monogamous  marriage  to  the  point  where  the 
roadway  lies  plainly  before  him  who  enters  upon  it 
with  the  end  and  object  at  all  clearly  sketched  against 
the  horizon.  It  will  take  endless  striving  and  a 
learning  over  and  over  again  that  love  must  be  care- 
fully and  constantly  tended  and  nourished  by  un- 
remitting giving  and  only  so  can  grow  to  a  ripened 
maturity.  George  Middlelon  is  worth  quoting  in 
what  he  says  of  marriage  in  the  Introduction  of 
''The  Road  Together." 

''The  spiritual  level  which  any  marriage  achieves 
depends  largely  upon  the  quality  of  those  who  make 
it.  Whatever  its  social  import,  of  which  few  are 
deliberately  conscious,  it  is  essentially  an  affair  of 
individuals.  As  they  are  and  as  they  react  to  each 
other,  so  will  the  marriage  be.  Since  it  is  only  in 
marriage  that  society  offers  free  and  complete  ex- 
pression between  them,  it  is  there  that  the  individual 
man  and  woman  are  most  tested,  most  realized,  and 
most  offended.' 

"If  one  considers  the  strangeness  of  sex — ^with  its 
vagrancy  and  variation — and  the  tremulous  psychic 
inheritances  which  uncontrollably  veer  our  acts  and 
emotions,  one  can  only  have  deep  charity  when  mar- 
riage ends  in  disillusion,  and  infinite  wonder  when 
it  reaches  rich  fulfilment.    Yet  marriage  endures 


234  MENTAL  HYGIENE 

somehow  between  these  two  extremes.  Its  bonds  are 
obvious  when  based  upon  religious  conviction,  the 
responsibilities  of  children,  the  fear  of  admitting 
failure,  and  the  pressure  of  convention. ' ' 

To  discuss  the  whole  question  of  divorce  would  be 
too  ambitious  an  undertaking  for  the  limits  imposed 
by  this  book.  I  can  only  revert  to  the  general  prin- 
ciple that  the  organization  of  society  is  becoming 
ever  more  complex,  is  developing  in  every  direction, 
and  correspondingly  each  of  its  component  institu- 
tions must  respond  to  the  larger  movement.  A  con- 
sideration of  marriage  solely  from  the  point  of  view 
of  a  contract  and  the  right  to  dissolve  it  only  upon 
such  grounds  as  are  now  included  in  the  statutes 
(adultery,  impotency,  cruel  and  inhuman  treatment, 
habitual  drunkenness)  can  no  longer  be  consid- 
ered sufficient  for  the  needs  of  present  day  society. 
Adultery,  inhuman  treatment,  habitual  drunkenness 
may  have  been  a  sufficient  catalogue  of  causes  for 
divorce  once  when  marriage  was  still  in  the  making 
and  had  incorporated  only  the  simplest  and  most  con- 
crete ideals,  but  to  continue  to  hold  them  over  against 
the  possibilities  for  human  development  and  useful- 
ness today  is,  to  put  it  mildly,  to  write  down  the  law 
again  as  hopelessly  in  the  rear  of  and  as  impeding 
progress  much  more  than  a  safe  conservatism  war- 
rants. 

The  more  thoughtful  have,  for  a  long  time,  felt  that 
the  whole  matter  of  marriage,  as  legally  dealt  with, 
needed  remodeling  along  the  lines  of  present  day 
possibilities  of  development.    Marriage  has  been  felt 


MISCELLANEOUS  PROBLEMS  235 

to  have  stuck  too  long  to  old  forms  and  to  be  sorely 
in  need  of  a  new  legal  and  social  setting.  The  tend- 
ency seems  to  be  to  separate  out  from  the  problem 
the  two  elements,  the  individual  and  the  social,  and  to 
consider  that  the  sexual  relation  per  se  is  in  essence 
individual,  that  is,  that  the  State  has  no  interest  in 
it  and  that  the  State  becomes  interested  in  the  sexual 
relation  only  upon  the  advent  of  the  child.  Along 
with  and  as  implied  in  this  way  of  considering  the 
marriage  relation  there  is  a  growing  tendency  to  fa- 
vour divorce  by  mutual  consent.  This  attitude,  far 
from  being  a  recent  one,  was  first  voiced  by  Milton. 
For  Milton  ^  marriage  was  a  private  matter  and  the 
causes  for  divorce  "'indisposition,  unfitness,  or  con- 
trariety of  mind,  arising  from  a  cause  in  nature  un- 
changeable, hindering  and  ever  likely  to  hinder,  the 
main  benefits  of  conjugal  society,  which  are  solace 
and  peace,"  and  he  protests  against  "authorizing  a 
judicial  court  to  toss  about  and  divulge  the  unac- 
countable and  secret  reason  of  disaffection  between 
man  and  wife."  Milton  fully  realized  the  strength 
of  the  argument  that  divorce  by  mutual  consent 
would  lead  to  license  and  stated  plainly  that  in  his 
belief  it  was  the  absence  of  reasonable  liberty  which 
led  to  license  and  so  arraigned  himself  with  many 
today  who  see  in  the  rigid  and  unyielding  marriage 
laws,  which  do  not  permit  the  remedying  of  a  mistake, 
one  of  the  roots  which  supports  prostitution  and  al- 
lied phenomena.    Havelock  Ellis  cites  the  deadly 

1  Cited  by  H.  Ellis:  "Studies  in  the  Psychology  of  Sex,"  Vol.  VI, 
"Sex  in  Relation  to  Society."     F.  A.  Davis  Co.,  Philadelphia,  1910. 


236  MENTAL  HYGIENE 

parallel  of  logic  when  he  suggests  that  inasmuch  as 
it  takes  the  consent  of  both  parties  to  enter  the  mar- 
riage relation  it  should  take  the  consent  of  both 
parties  to  continue  it,  and  Ellen  Key  reminds  us  that 
broken  engagements  were  at  one  time  considered  to 
be  as  humiliating  as  divorce  is  now. 

As  regards  the  welfare  of  the  child  it  would  seem 
that  a  house  which  is  no  longer  a  home  in  the  true 
sense  is  not  a  fitting  place  in  which  to  rear  a  child 
and  that  there  does  not  seem  to  be  any  good  reason 
why  adequate  provision  may  not  be  made,  and  better 
provision  for  that,  for  the  care  of  the  child  without 
keeping  the  parents  forcibly  together.  To  insist  that 
the  parents  make  reasonable  and  proper  provision 
for  the  care  of  the  child  is  a  proper  function  of  the 
State  through  its  judicial  authority. 

The  feeling  thus  seems  to  be  growing  that  the 
whole  marriage  situation  needs  recasting  and  that 
divorce  should  represent  in  its  greater  freedom  a 
larger  personal  liberty,  a  liberty,  not  that  makes  for 
license,  but  a  liberty  that  is  as  great  as  is  consistent 
with  the  largest  opportunity  for  personal  expression 
and  so  will  tend  to  rob  license  of  its  excuse. 

It  should  never  be  lost  sight  of  that  in  all  intimate 
human  relations,  particularly  that  of  marriage,  a 
great  deal  of  the  incapacity  to  adjust,  and  so  a  great 
deal  of  the  unhappiness,  results  from  defects  in  the 
individual  of  a  neurotic  nature  and  that  the  proper 
way  of  dealing  with  such  maladaptations  is  by  mod- 
ern methods  of  therapeutics  (psychoanalysis)  ad- 
dressed to  the  individual.    A  very  large  number  of 


MISCELLANEOUS  PEOBLEMS  237 

unhappy  marriages  are  dependent  upon  such  con- 
ditions. Divorce  under  such  circumstances,  while  it 
might  relieve,  would  not  touch  the  basis  of  the  diffi- 
culty nor  prevent  its  recurrence  at  the  next  favour- 
able opportunity.  It  would  be  a  make-shift,  not  the 
real  solution. 

THE   WOMAN   MOVEMENT 

The  distorting  mechanisms  are  here  quite  the  same 
as  those  that  prevent  clear  vision  in  the  matter  of 
divorce,  because  we  are  dealing  again  with  a  prob- 
lem which  is  eminently  a  sexual  one,  and  the  slogan 
''woman's  place  is  in  the  home"  serves  equally  as  a 
distorting  rationalization  to  deflect  attention  from 
the  real  issues  and  put  a  premium  on  leaving  things 
as  they  are — the  dry  rot  that  calls  itself  conserva- 
tism. So  good  a  rationalization  is  it  in  fact  that  it 
serves  yet  to  delude  many  intelligent  and  fair  minded 
people.  In  these  latter  it  probably  expresses  a  satis- 
faction with  present  conditions  for  which  they  are 
glad  to  get  such  a  respectable  expression. 

The  woman  movement  should  be  looked  upon  pri- 
marily as  a  movement  to  gain  for  woman  a  larger 
world  in  which  to  find  expression.  She  has  de- 
veloped, long  since,  beyond  the  possibilities  which 
present  to  the  average  housewife  and  her  unem- 
ployed energies  seek  new  fields  to  exploit.  Modern 
progress  has  not  only  placed  education  within  the 
reach  of  woman  but  it  has  taken  over  a  vast  quantity 
of  her  activities  so  that  she  no  longer  has  the  making 
of  clothes,  the  weaving  of  cloth  and  like  things  to  do. 


238  MENTAL  HYGIENE 

The  organized  productivity  of  the  factory  and  the 
department  store  not  only  do  all  of  this  work  for  her, 
but  do  it  vastly  better  than  she  could  do  it  and,  con- 
sidering its  quality,  cheaper.  In  this  and  many 
other  ways  woman  has  had  her  work  taken  away 
from  her  and  so  it  has  become  increasingly  necessary 
that  she  should  find  outlets  for  these  unused  energies. 
Her  cry  for  the  vote  is  merely  the  erection  of  a 
standard  under  which  to  marshal  her  forces.  It  is 
not  the  vote  primarily  that  she  wants,  it  is  an  ade- 
quate outlet  for  her  energies  in  satisfying  self-ex- 
pression and  the  ''vote"  is  only  the  symbol  for  this 
great  need,  far  greater  than  the  symbol,  at  its  surface 
value  indicates. 

In  the  woman  movement  woman  is  at  last  finding 
herself.  Released  from  the  drudgery  of  the  house- 
wife by  the  genius  of  modern  business  enterprise  her 
energies  are  made  available  for  better  and  higher 
things.  To  attempt  to  prevent  her  from  realizing 
herself  and  to  succeed  would  be  a  tragedy.  Her  suc- 
cess means  the  raising  of  the  whole  love  story  to  a 
higher  plane,  the  removing  of  it  forever  from  the 
barter  of  the  marriage  mart,  and  because  woman  is 
independent  a  demand  for  something  more  than 
board  and  lodging.  When  man  has  to  meet  woman 
as  an  economic  equal  then  marriage  will  in  truth  be 
free  and  the  natural  instincts,  which  are  always  seek- 
ing for  expression  at  ever  higher  levels,  can  be 
trusted  to  make  for  an  improved  eugenic  mating. 
In  fact  the  woman  movement  is  a  distinct,  and  to  my 
mind,  the  most  important  because  most  hopeful,  step 


MISCELLANEOUS  PROBLEMS  239 

in  the  direction  of  an  improved  race  through  better 
mating.  The  great  bitterness,  the  long  duration,  and 
the  severity  of  the  conflict  necessary  to  secure  for 
woman  that  recognition  by  society  which  will  give 
her  her  rightful  opportunities  for  self-realization 
only  indicate  the  distorting  power  of  instinct  which 
always  makes  the  road  of  upward  progress  so  hard. 

FEEE   SPEECH 

Not  long  ago  there  was  a  prosecution  in  one  of  our 
States  for  blasphemy.  The  prosecution  was  had  un- 
der a  statute  which  had  been  enacted  in  the  middle 
of  the  seventeenth  century  and  had  presumably  been 
a  dead  letter  for  a  long  time  until  revived  upon  this 
particular  occasion.  The  interesting  thing  about  it 
was  that  practically  all  of  the  social  conditions  which 
were  in  existence  at  the  time  the  statute  was  enacted, 
and  in  particular  the  state  of  affairs  at  which  the 
statute  was  aimed,  had  ceased  to  exist.  Neverthe- 
less the  statute  was  taken  at  its  face  value  and  the 
defendant  was  convicted.  The  words  of  the  statute 
which  were  used  in  the  seventeenth  century  were 
given  the  meanings  which  they  had  acquired  in  the 
meantime  so  blind  is  the  law  to  the  spirit  of  change 
which  animates  all  things.  The  outward  form  of  the 
symbol  had  remained  the  same  through  the  years 
but  that  was  all,  its  inner  meanings  had  become  rad- 
ically different.^ 

The  tremendous  effort  which  the  law  makes  to 

2  See  my  discussion  of  the  value  of  the  symbol  as  a  carrier  of 
energy  in  "Mechanisms  of  Character  Formation." 


240  MENTAL  HYGIENE 

catcli  this  wonderful,  moving  thing  we  call  life  in 
a  formula,  to  fix  it  in  a  series  of  words  past  any  pos- 
sibility of  misunderstanding  or  change  is  at  times 
almost  pathetic.  An  effort  like  the  following  shows 
most  painfully  how  elaborately  the  law  can  fail  and 
unfortunately  tends  to  make  law  itself  almost  ridicu- 
lous. Coupled  with  a  growing  tendency  to  evade  in 
every  possible  way  the  real  issues  and  lay  weight 
upon  the  unimportant,  unessential,  technical  details 
it  has  brought  the  law  into  much  disrepute,  so  that 
it  may  have  to  be  corrected  by  very  radical  means. 
The  law  has  always  been  dangerously  wedded  to  the 
past ;  it  must  learn  to  look  ahead  as  well  as  behind. 
The  example  in  point  is  taken  from  the  New  York 
State  Criminal  Code  and  runs  as  follows : 

''§  1141,  Obscene  prints  and  articles. 

**1.  A  person  who  sells,  lends,  gives  away  or 
shows,  or  offers  to  sell,  lend,  give  away,  or  show,  or 
has  in  his  possession  with  intent  to  sell,  lend  or  give 
away,  or  to  show,  or  advertises  in  any  manner,  or 
who  otherwise  offers  for  loan,  gift,  sale  or  distribu- 
tion, any  obscene,  lewd,  lascivious,  filthy,  indecent  or 
disgusting  book,  magazine,  pamphlet,  newspaper, 
story  paper,  writing  paper,  picture,  drawing,  pho- 
tograph, figure  or  image,  or  any  written  or  printed 
matter  of  an  indecent  character;  or  any  article  or 
instrument  of  indecent  or  immoral  use,  or  purporting 
to  be  for  indecent  or  immoral  use  or  purpose,  or  who 
designs,  copies,  draws,  photographs,  prints,  utters, 
publishes,  or  in  any  manner  manufactures,  or  pre- 
pares any  such  book,  picture,  drawing,  magazine, 


MISCELLANEOUS  PROBLEMS  241 

pamphlet,  newspaper,  story  paper,  writing  paper, 
figure,  image,  matter,  article  or  thing  or  who  writes, 
prints,  publishes,  or  utters,  or  causes  to  be  written, 
printed,  published,  or  uttered  any  advertisement  or 
notice  of  any  kind,  giving  information,  directly  or 
indirectly,  stating,  or  purporting  so  to  do,  where, 
how,  of  whom,  or  by  what  means  any,  or  what  pur- 
ports to  be  any,  obscene,  lewd,  lascivious,  filthy,  dis- 
gusting or  indecent  book,  picture,  writing,  paper, 
figure,  image,  matter,  article  or  thing,  named  in  this 
section  can  be  purchased,  obtained  or  had  or  who 
has  in  his  possession,  any  slot  machine  or  other  me- 
chanical contrivance  with  moving  pictures  of  nude 
or  partly  denuded  female  figures  which  pictures  are 
lewd,  obscene,  indecent  or  immoral,  or  other  lewd, 
obscene,  indecent  or  immoral  drawing,  image,  article 
or  object,  or  who  shows,  advertises  or  exhibits  the 
same,  or  causes  the  same  to  be  shown,  advertised,  or 
exhibited,  or  who  buys,  owns  or  holds  any  such  ma- 
chine with  the  intent  to  show,  advertise  or  in  any 
manner  exhibit  the  same ;  or  who, 

*'2.  Prints,  utters,  publishes,  sells,  lends,  gives 
away  or  shows,  or  has  in  his  possession  with  intent 
to  sell,  lend,  give  away  or  show,  or  otherwise  offers 
for  sale,  loan,  gift  or  distribution,  any  book,  pam- 
phlet, magazine,  newspaper  or  other  printed  paper 
devoted  to  the  publication,  and  principally  made  up 
of  criminal  news,  police  reports,  or  accounts  of  crim- 
inal deeds,  or  pictures,  or  stories  of  deeds  of  blood- 
shed, lust  or  crime ;  or  who, 

**3.  In  any  manner,  hires,  employs,  uses  or  per- 


242  MENTAL  HYGIENE 

mits  any  minor  or  child  to  do  or  assist  in  doing  any 
act  or  thing  mentioned  in  this  section,  or  any  of  them, 

**Is  guilty  of  a  misdemeanor,  and,  upon  convic- 
tion, shall  be  sentenced  to  not  less  than  ten  days  nor 
more  than  one  year  imprisonment  or  be  fined  not  less 
than  fifty  dollars  nor  more  than  one  thousand  dol- 
lars or  both  fine  and  imprisonment  for  each  offence." 

The  reiteration  of  the  prohibition  belongs  to  that 
psychological  phenomenon  of  infantile  type  which 
seeks  to  bring  things  to  pass  by  repeated  emphatic 
affirmation ;  if  one  only  thinks  hard  enough  it  really 
must  be  so.  It  is  a  common  way  of  deluding  oneself. 
Disagreeable  things  are  refused  belief  until  they 
force  themselves  upon  attention  and  then  often  it  is 
too  late  to  apply  a  remedy.  In  the  matter  of  the 
law  it  is  the  same  sort  of  error  as  was  pointed  out 
in  the  legal  definition  of  crime  (Chap.  V). 

Of  course  it  will  always  be  necessary  to  attempt 
a  formulation  of  results  legal  as  well  as  scientific, 
only  it  should  always  be  remembered  that  no  formu- 
lation can  be  perfect  and  that  as  time  passes  its  im- 
perfections become  greater.  Then  such  a  stupid  re- 
sult as  occurred  in  the  trial  for  blasphemy,  men- 
tioned at  the  beginning  of  this  section,  could  not  oc- 
cur. 

There  has  always  been  controversy  whether  speech 
should  be  free  or  under  certain  restrictions.  The 
trouble  is  that  restrictions  often  proceed  from  ulte- 
rior (unconscious)  motives,  and  freedom  is  often 
used  for  ulterior  (unconscious)  ends.  Without  at- 
tempting to  solve  this  question,  as  I  have  not  at- 


MISCELLANEOUS  PROBLEMS  243 

tempted  to  solve  others,  I  hold  merely  to  what  I  be- 
lieve the  important  principle  of  recognizing  their 
mechanisms.  If  these  were  recognized  and  the  uL 
terior  motives  could  be  made  visible,  because  their 
language  was  known,  the  disguise  would  no  longer  be 
useful  and  much  of  the  material  which  makes  for  the 
differences  of  opinion  would  naturally  fall  away. 

ILLEGITIMACY 

The  fearful  price  which  society  has  always  made 
the  illegitimate  child  pay  for  what  was  no  fault  of  his 
has  always  struck  the  thoughtful  and  kindly  as  one 
of  the  most  crying  injustices,  yet  it  has  not  been  cor- 
rected but  continues  in  its  errant  path  with  the  per- 
tinacity and  unintelligence  of  instinct. 

This  manifestation  of  an  instinctive  tendency  will 
be  recognized  as  an  example  of  antipathic  feeling  ex- 
hibited by  the  herd.  Just  as  the  herd  in  miniature, 
as  the  jury,  projects  its  hate  upon  the  criminal  be- 
cause of  his  antisocial  conduct,  so  has  the  herd  pro- 
jected its  hate  upon  the  concrete,  personal  embodi- 
ment of  the  evidence  of  an  antisocial  act. 

Illegitimacy  is  contrary  to  the  interests  of  the  herd 
and  therefore  must  be  punished,  atoned  for.  This 
necessity  for  punishment  and  atonement  is  the  pri- 
mary necessity,  and  so  far  as  its  expression  is  con- 
cerned and  the  relief  which  follows  such  expression 
it  might  be  said  to  be  incidental  as  to  the  particular 
person  who  had  to  suffer.  The  natural  sufferer  is 
the  child  because  he  more  completely  embodies  the 
undesirable   feature   against  which   society  is   ar- 


244  MENTAL  HYGIENE 

raigned.  Sex  relations  which  have  not  been  legiti- 
mized spring  at  once  into  their  real  antisocial  sig- 
nificance upon  the  appearance  of  the  illegitimate 
child. 

It  of  course  strikes  one  as  unreasonable  and  un- 
just that  the  child  should  be  made  to  suffer.  But 
such  is  the  course  of  events.  Expiation  has  to  find 
its  outlet.  The  custom  has  been  recorded  of  hang- 
ing the  thief  first  and  investigating  afterward,  such 
is  the  necessity  for  expiatory  forms  of  expression. 
It  is  only  in  a  later  developmental  stage  when  it  be- 
comes possible  to  wait  and  adjust  the  hanging  to  the 
actual  thief.  Such  waiting  implies  the  possibility  of 
repression  because  if  the  thief  cannot  be  found  then 
the  feeling  will  find  no  outlet  and  so  can  only  be  ex- 
pected at  a  relatively  late  stage  in  social  develop- 
ment. It  will  require  a  little  further  development, 
for  which  I  think  we  are  about  ready,  to  legitimize  by 
statute  the  illegitimate  child  and  thus  give  him  an 
equal  chance  before  the  law  to  make  good  in  the 
game  of  life.  To  argue  that  this  would  tend  to  fur- 
ther illicit  relations  I  think  can  only  be  a  rationaliza- 
tion for  a  continuation  in  the  present  state  of  affairs. 
The  instinct  which  prompts  such  relations  is  surely 
not  intended  to  further  such  results. 

To  argue  as  some  people  do  that  every  suggested 
change  in  the  established  order  of  things,  particu- 
larly if  it  has  to  do  with  sexual  matters  and  aims  at 
a  greater  freedom  of  personal  expression  is  going  at 
once  to  plunge  society  in  an  orgie  of  sexual  promis- 


MISCELLANEOUS  PROBLEMS  245 

cuity  is  to  have  very  little  faith  in  human  nature  and 
less  realization  of  the  nature  of  the  struggles  which 
are  taking  place  in  men's  bosoms  and  which  only 
come  to  outward  expression  in  such  suggestions. 
Milton's  belief,  already  referred  to,  that  it  is  too 
rigid  restrictions  which  lead  to  license  I  believe 
shows  a  deeper  insight  into  human  nature.  Man  is 
always  striving  for  better  and  higher  adjustments. 
In  so  doing  he  is  but  the  medium  through  which  the 
great  creative  energy  of  the  universe  is  manifesting 
itself.  The  disturbances  which  mark  his  course  are 
but  the  outward  evidences  of  such  strivings.  A 
broader  appreciation  of  the  mechanisms  by  which 
man  projects  his  instinctive  shortcomings  upon 
others  would  relieve  the  illegitimate  child  of  a  legal 
disability  for  no  fault  of  his. 

SOCIAX.   HYGIENE 

The  social  hygiene  movement  has  arisen  in  an  ef- 
fort to  control  the  exercise  of  the  sex  instinct  and 
help  force  it  into  socially  useful  ways  of  expression. 
It  has  met  with  the  tremendous  opposition  which  all 
efforts  must  which  try  to  bring  into  the  field  of  clear 
conscious  awareness  our  instinctive  tendencies,  and 
it  has  succeeded  in  so  far  as  it  has  succeeded  in  doing 
so.  The  process  of  development  is  a  process  in  the 
human  animal  of  socializing  instincts  and  the  social 
hygiene  movement  has  helped  to  get  people  to  recog- 
nize their  sexual  instinct  consciously,  for  it  is  only 
when  we  can  deal  consciously  with  our  instincts  that 


246  MENTAL  HYGIENE 

we  can  bring  them  under  the  control  of  intelligence 
and  direct  their  use.  Otherwise,  instead  of  running 
our  instincts  our  instincts  run  us. 

The  effort  made  in  this  movement  to  turn  the  sex- 
ual instinct  into  channels  of  greater  usefulness  is 
made  ostensibly  to  prevent  venereal  disease  and  the 
thousand  and  one  ills  that  are  traceable  to  this 
source.  It  brings  to  view,  in  spite  of  all  sorts  of  at- 
tempts to  escape  seeing,  the  unlovely  picture  of  the 
havoc  wrought  by  the  misdirected  sex  instinct.  In 
this  way  it  co-operates  with  nature,  for  nature,  by 
exacting  the  penalty  of  venereal  disease,  is  con- 
stantly tending  to  cut  off  the  operation  of  the  sex 
instinct  at  these  lower  levels  of  manifestation  (pros- 
titution) and  so  save  its  energies  for  better  uses 
which  shall  be  truly  creative,  race  preservative. 
Venereal  disease  tends  to  do  this,  not  only  because  it 
causes  suffering  but  because  it  exercises  a  true  selec- 
tive activity  eliminating  by  death  a  great  many 
(syphilis  of  the  central  nervous  system)  and  in  count- 
less numbers  cutting  off  the  germ  plasm  by  sterilizing 
inflammations  (inflammatory  occlusion  of  the  Fallo- 
pian tubes).  The  far  reaching  and  radical  results 
of  venereal  infection  in  these  regards  have  not  been 
at  all  adequately  studied. 

Of  course  the  way  of  nature  in  this  as  in  other 
matters  (tuberculosis)  is  tremendously  wasteful  and 
much  good  material  is  destroyed  in  reaching  the  bad. 
It  is  only  the  general  result  that  is  to  be  commended. 
It  remains  to  be  seen  whether  man,  by  the  use  of 
his  intelligence,  can  do  better. 


MISCELLANEOUS  PROBLEMS  247 

DANGEROUS   OCCUPATIONS 

The  efforts  which  are  being  made  these  days  to 
protect  the  working  man  from  injury  are  addressed, 
not  solely  to  the  individual  welfare  of  the  worker,  but 
have  become  social  movements  because  it  is  equally 
of  importance  to  the  herd  to  preserve  its  members 
from  injuries  and  keep  them  at  a  maximum  level  of 
efficiency.  The  degree  of  efficiency,  the  degree  of 
happiness,  and  the  degree  of  social  usefulness  of  an 
individual  are  all  aspects  of  the  same  thing,  namely, 
the  individual-society  relation;  they  therefore  can- 
not properly  be  considered  apart.  It  is  for  such 
reasons  that  their  consideration  properly  comes 
within  the  domain  of  mental  hygiene.  This  will  be 
at  once  evident  if  what  I  said  about  physical  dis- 
ability as  one  of  the  causes  of  dependency  (Chap. 
VII)  is  recalled.  A  full,  a  happy,  and  a  useful  life 
are  all  different  ways  of  saying  the  same  thing.  To 
save  a  person  from  injury  is  to  help  to  keep  him 
happy,  to  keep  him  happy  is  to  keep  him  efficient,  to 
keep  him  happy  and  efficient  is  to  keep  him  useful. 
Safety  first  devices,  industrial  insurance,  workmen's 
compensation  acts,  factory  sanitation,  legislation  re- 
garding dangerous  trades,  etc.,  etc.,  are  all  in  their 
widest  sense  problems  in  mental  hygiene.  They 
may  of  course  involve  many  ancillary  considera- 
tions, but  in  the  large  they  deal  with  the  individual- 
society  relationship,  which  relationship  is  the  field 
in  which  the  psyche  functions,  in  fact  which  ^5  the 
psyche. 


248  MENTAL  HYGIENE 

Not  only  has  hygiene  been  stressed  in  this  work  of 
studying  the  dangerous  occupations  but  the  attack 
has  come  to  be  made  directly  from  the  mental  aspect 
of  the  problem  although,  as  is  so  often  the  case,  it 
would  appear  otherwise.  For  example,  it  is  gener- 
ally concluded  that  efficiency  is  at  its  lowest  ebb  after 
a  holiday  and  also  after  lunch  if  some  alcohol  has 
been  taken  with  the  meal.  These  are  the  times,  too, 
when  in  factories  accidents  are  most  apt  to  occur. 
While  this  and  similar  problems  have  been  attacked 
under  the  designation  of  problems  in  efficiency  they 
are  easily  seen  to  be  primarily  psychological  prob- 
lems. Many  aspects  of  this  larger  problem  have 
received  attention  of  course  varying  in  each  particu- 
lar case,  such  as  the  prohibition  of  alcohol  not  only 
during  working  hours  but  altogether,  the  relation  of 
Sunday  and  holidays  to  efficiency,  the  value  and  best 
use  of  rest  periods  during  the  working  day,  pro- 
vision of  amusements,  erection  of  dwellings  and 
renting  at  a  reasonable  price,  establishment  of  co- 
operative stores,  self-government  among  employes, 
profit  sharing  plans,  schemes  for  rivalry  between 
groups  of  workingmen,  etc. 

All  these  various  movements  are  indications  of  a 
growing  socialism  in  the  best  sense.  The  man  who 
employs  large  numbers  of  people  and  profits  by  their 
labours  and  is  permitted  to  do  so  by  the  herd  by  the 
granting  of  a  franchise,  the  issuance  of  articles  of 
incorporation  or  in  other  ways  directly  or  indirectly, 
thereby  assumes  an  obligation  towards  the  herd  and 
that  particular  group  of  its  individuals  who  become 


MISCELLANEOUS  PROBLEMS  249 

his  employes.  That  responsibility  means  that,  be- 
ing in  the  position  of  power,  he  shall  be  looked  to  to 
take  care  of  the  health,  mental  and  physical,  of  his 
employes,  to  interest  himself  in  their  welfare  and 
in  every  way  do  those  things  which  not  only  may 
make  them  better  employes  but  better  citizens.  The 
herd  demands  of  the  factory  that  it  serve  as  a  social 
centre,  as  a  centre  of  social  nsefulness  in  return  for 
the  privileges  granted  by  society. 

VOCATIONAL  PSYCHOLOGY 

In  connection  with  the  question  of  dangerous 
trades  and  similar  questions  has  arisen  the  depart- 
ment of  vocational  psychology.  In  its  general 
reaches  it  attempts  to  fit  the  man  and  the  job  by  a 
study  of  the  man  and  a  mapping  of  his  qualifications, 
and  so  learning  his  capacities.  Its  cruder  applica- 
tions are,  for  example,  the  determination  of  the  ca- 
pacity of  the  individual  as  to  the  rapidity  with  which 
he  can  make  certain  movements  required  by  certain 
machinery  and  then  either  turning  down  the  par- 
ticular applicant  for  work  on  a  certain  machine,  or 
else  slowing  down  the  machine  and  so  making  the 
man  and  the  machine  intermember.  In  this  way  are 
many  accidents  avoided  which  depended  upon  a  ma- 
chine working  at  a  speed  to  which  the  worker  could 
not  adjust. 

From  this  sort  of  work  this  branch  of  psychology 
has  branched  out  in  an  effort  to  determine  more 
subtle  issues,  to  fit  men  to  complex  situations.  In 
this  way  have  developed  such  problems  as  the  psy- 


250  MENTAL  HYGIENE 

chology  of  advertising  and  such  efforts  as  the  effort 
to  work  out  the  desirable  traits  which  a  salesman 
should  have.  Of  course  each  occupation,  each  busi- 
ness has  its  particular  problems  and  therefore  its 
particular  ways  in  which  psychology  can  be  applied. 
At  present  this  is  a  new  and  largely  fallow  field  of 
endeavour. 

Not  only  is  vocational  psychology  of  value  in  fit- 
ting the  man  and  the  job  but  it  also  has  a  function, 
which  is  one  of  its  possibilities  for  future  develop- 
ment, of  determining  the  capacity  of  the  individual. 
We  have  means  now  of  telling  something  of  a  man 's 
muscular  strength  and  by  study  under  increasing 
demands  something  of  his  ability  to  withstand 
fatigue.  We  can  even  tell  something  of  the  muscu- 
lar capacity  of  the  heart  and  the  probabilities  of  its 
standing  up  under  stress.  In  other  words  we  have 
developed  the  ability  to  measure  the  capacity  of 
some  organs  but  not  of  the  mind.  To  be  sure  we  can 
say  in  cases  of  marked  defect  that  a  given  boy  will 
never  be  able  to  do  more  than  run  errands  or  answer 
the  door  bell  or  such  similar  occupations,  but  to  tell 
whether  a  given  person  has  mental  qualities  which 
would  enable  him  to  succeed  in  a  given  trade  or  pro- 
fession is  a  question  for  the  future  of  vocational 
psychology.  It  is,  however,  an  important  direction 
for  development. 

FADS 

There  are,  from  time  to  time,  outcrops  of  peculiar 
fashions  in  art,  literature,  music,  or  society  is  seized 


MISCELLANEOUS  PEOBLEMS  251 

in  the  grip  of  some  new  cure-all  (Christian  Science, 
vegetarianism),  or  some  humanitarian  or  philan- 
thropic endeavour  (prevention  of  cruelty  to  animals, 
anti-noise  crusades),  or  some  new  spurt  of  social  re- 
form causes  unwonted  activity  in  suppressing  vice 
or  saloons.  Such  activities  which  rise,  have  a  short 
but  often  phenomenal  career,  and  then  fade  away 
never  to  be  heard  of  again,  or  else  spasmodically  re- 
cur from  time  to  time,  or  continue  to  absorb  the  at- 
tention of  a  larger  or  smaller  social  group,  are  in- 
numerable. 

All  of  these  activities  must  of  course  be  under- 
stood as  serving  as  avenues  of  expression  for  those 
who  are  engaged  in  them  and  to  have  come  into  ex- 
istence because  they  more  or  less  adequately  answer 
that  need  and  continue  to  exist  as  long  as  they  fulfil 
it.  They  are  all  trials  by  the  few  to  make  a  uni- 
versal appeal  and  they  live  and  prosper  and  die  just 
in  proportion  to  the  extent  and  depth  of  that  appeal. 
A  work  of  art,  like  some  of  the  strange  creations  of 
recent  years,  which  no  one  can  understand  or  inter- 
pret and  which  is  merely  a  sort  of  picture  puzzle  to 
all  who  look  at  it,  can  only  mean  that  as  an  expres- 
sion it  is  exquisitely  individual  and  therefore  strikes 
no  chord  in  its  appeal  to  others.  Such  works  create 
a  furore  for  a  time  because  they  stir  the  interests  of 
those  who  are  looking  for  a  new  sensation. 

I  have  given  in  the  preceding  pages  enough  illus- 
trations of  the  place  that  mental  life  plays  in  our 
civilization.  We  find  it  in  all  sorts  of  problems  even 
when,  from  the  surface,  it  might  well  not  have  been 


252  MENTAL  HYGIENE 

suspected.  It  must  not  be  lost  sight  of  that  all 
phenomena  which  have  to  do  with  the  conduct,  the 
behaviour  of  the  individual  as  a  whole  are  psycho- 
logical so  that,  from  this  point  of  view,  we  can  un- 
derstand the  wide  prevalence  of  the  mental  in  the 
various  social  problems  that  look  at  first  sight  to  be 
merely  problems  of  sanitation,  fatigue,  hygiene,  po- 
lice regulation  or  what  not. 

Somehow,  some  way  the  tendency  of  all  life  is  up- 
ward, forward  on  the  path  of  development,  evolu- 
tion. It  is  only  by  bearing  in  mind  that  there  is  such 
a  forward  urge  which  has  of  necessity  to  encounter 
and  overcome  obstacles  that  we  can  understand  the 
psychological  conflict.  The  mental  phenomena  as 
we  see  them  are  the  results,  at  the  psychological  level 
of  reaction,  of  the  conflict  between  this  forward  urge 
and  the  backward  staying  tendency.  The  fads  and 
fancies  of  men  are  feelers  which  he  tentatively 
thrusts  forward  into  the  world  to  find  out  if  he  can 
safely  go  in  that  direction.  Or,  more  aptly,  like  the 
psuedopodia  of  an  amoeba  which  is  gradually  ex- 
tended to  be  quickly  withdrawn  if  it  meets  an  un- 
favourable reception  or  into  which,  on  the  contrary, 
if  the  conditions  are  found  to  be  favourable,  the 
whole  animal  translates  itself. 

The  meaning  of  these  and  other  phenomena  can 
only  be  understood  by  medicine  when  its  strict  in- 
dividualism is  laid  aside  and  it  is  realized  that  there 
is  a  social  as  well  as  a  tissue  pathology.  As  physi- 
cians come  more  and  more  to  take  up  these  larger 
issues,  as  the  physician  comes  to  represent  the  inter- 


MISCELLANEOUS  PROBLEMS  253 

ests  of  the  herd  as  well  as  the  interests  of  his  indi- 
vidual patient,  we  can  speak  of  the  socialization  of 
medicine. 

WEALTH 

Money  is  the  energy  symbol  of  modern  society 
which  stands  for  human  effort.  Work  is  repre- 
sented in  money  and  then  money,  because  it  can  com- 
mand, becomes  a  symbol  of  power  and  is  accumu- 
lated for  its  own  sake  because  it  confers  power.  It 
would  seem  that  the  best  societies  are  on  the  point  of 
superseding  money  as  the  one  and  only  energy  sym- 
bol which  will  be  recognized  and  that  there  is  a  grow- 
ing tendency  to  look  deeper  than  is  sufficient  to  vSee 
the  single  fact  of  wealth.  As  has  been  implicitly 
emphasized  all  through  this  book,  the  new  value 
seems  to  be  a  social  value — social  usefulness  seems 
to  be  coming  to  be  a  more  and  more  recognized  and 
appreciated  value. 

Of  course  the  individual  and  the  community  stand 
in  reciprocal  relations,  one  to  the  other,  and  what 
affects  one  affects  the  other.  But  their  interests 
often  cross  so  that  quite  naturally  we  find  that  there 
are  times  in  the  history  of  a  people  when  the  claims 
of  first  one  and  then  the  other  is  in  the  ascendant. 
[With  us  individualism  has  been  dominant  for  a  long 
period  and  perhaps  such  an  enormous  force  as  a 
world  war  was  necessary  to  make  us  turn  to  prob- 
lems of  nation-wide  co-operation  for  the  common 
good.  Under  these  circumstances  a  redistribution 
of  wealth  on  a  more  or  less  extensive  scale  is  in- 
evitable and  much  which  is  held  now  by  right  of  pri- 


254  MENTAL  HYGIENE 

vate  ownership  will  find  its  way  to  the  possession  in 
common  of  the  herd.  The  distribution  of  wealth 
follows  the  swing  of  the  pendulum  between  indi- 
vidualism and  collectivism.  Money,  therefore,  par- 
takes of  the  properties  of  both. 

The  value  of  money,  therefore,  is  not  intrinsic — 
that  is  the  delusion  of  the  miser.    Its  value  lies  in 
what  one  is  able  to  do  with  it — as  an  energy  symbol 
it  attains  its  real  value  when  its  potential  energy  is 
made   kinetic.    For   the   individual,    therefore,   its 
value  is  as  a  means  which  enables  him  to  express 
himself,    and    from    the    standpoint    of    the    herd 
it  attains  value  when  such  forms  of  expression  are 
chosen  as  have  social  usefulness.    From  this  point 
of  view  it  is  easy  to  see  that  arbitrary  limits  cannot 
be  placed  upon  the  amount  of  money  which  a  given 
individual    needs.    Persons    of    limited    capacities 
need  much  less  than  persons  of  great  capacities. 
The  limited  individual  may  not  only  be  well  satisfied 
with  very  little  but  he  may  well  be  much  better  off 
with  an  income  which  fits  his  needs  (by  this  I  mean 
his  inner  needs — ^his  needs  for  expression)  than  one 
materially  in  excess  of  these  needs.    The  person  of 
larger  capacities,  on  the  other  hand,  may  well  find 
himself  cramped  by  an  income  that  would  literally 
seem  stupendous  to  those  of  smaller  vision.    When 
such  a  large  calibred  man  engages  in  enterprises 
that  employ  thousands  of  men  and  so  becomes,  in  a 
way,  responsible  for  a  considerable  group,  he  ac- 
quires social  responsibilities,  which  if  he  discharges 


MISCELLANEOUS  PROBLEMS  255 

well  society  may  some  day  elect  not  to  penalize  him. 
To  tax  equally  the  captain  of  industry  who  is  of  ines- 
timable social  worth  in  thousands  of  ways  and  the 
wealthy  defective  who  idles  away  his  time  and  dis- 
sipates his  energies  in  all  sorts  of  useless  and  per- 
haps vicious  ways,  is  manifestly  unfair  and  unwise 
though  just  at  present  there  is  no  sufficiently  well 
worked  out  basis  of  valuation  to  replace  income  as 
a  practical  working  measure.  Speed  the  day  of  its 
coming ! 

IDLENESS 

One  has  only  to  look  about  to  realize  the  liter- 
ally enormous  amount  of  idleness  and  waste  of  time 
there  is.  And  of  course  the  worst  of  it  is  that  idle- 
ness is  not  solely  negative  in  its  results.  Persons 
who  are  persistently  idle  to  outward  appearances, 
are  really  quite  busy  acquiring  vicious  habits  of 
thought  and  feeling  which  are  destructive  in  their 
tendencies. 

If  one  takes  a  ride  of  four  or  five  hours  on  a  rail- 
road train  he  may  note  that  fully  nine-tenths  of  the 
people  are  apparently  content  to  let  that  four  or  five 
hours  slip  by  without  making  the  slightest  attempt 
to  accomplish  anything.  Beyond  looking  over  the 
daily  paper  they  eat,  nap,  and  perhaps  spend  the  rest 
of  the  time  idly  looking  out  the  window  or  reading 
a  short  story  or  trashy  novel.  And  yet  one  often 
hears  such  persons  complain  of  the  tediousness  of 
the  journey,  and  nervous  and  restless  act  as  if  they 
could  hardly  wait  for  its  ending  even  though  they 


256  MENTAL  HYGIENE 

may  have  little  that  is  more  definite  or  useful  at  the 
other  end. 

Of  course  some  of  these  people  are  tired  and  are 
taking  an  opportunity  for  a  well  earned  rest.  Nat- 
urally I  do  not  refer  to  them. 

This  example  of  the  railroad  journey  may  be  taken 
as  an  illustration  of  how  many  people  go  through 
life,  interested  only  in  sensational  occurrences  or 
such  immediate  matters  as  bodily  needs,  working  by 
the  clock  and  only  looking  for  the  time  to  quit,  see- 
ing in  all  work  only  drudgery  and  not  opportunity, 
seeking  only  idleness,  pleasure,  freedom  from  care, 
sensation. 

All  this  idleness,  all  this  lack  of  interest  in  spite 
of  the  fact  that  the  tiniest  speck  of  dust  contains  the 
mystery  of  the  universe,  that  any  one  of  the  hun- 
dreds of  buzzing,  crawling  bugs  that  one  may  see 
on  a  summer's  day  will  prove  on  the  most  casual 
observation  to  be  bewilderingly  beautiful  and  on 
more  careful  study  equally  wonderful.  Every 
breath  of  air  and  every  sound  asks  a  thousand  ques- 
tions and  every  rock  can  tell  a  story  more  fascinat- 
ing than  can  be  found  in  any  of  the  popular  maga- 
zines, while  nothing  that  man  can  do  in  the  way  of 
creating  a  sensation  equals  in  power,  magnificence 
and  grandeur  the  thunder  storm.  What  is  the  mat- 
ter? One  is  tempted  to  blame  the  educational 
scheme  which  sends  out  into  this  wonderful  world 
so  many  who  "have  eyes  to  see,  and  see  not"  and 
''have  ears  to  hear,  and  hear  not.'* 


MISCELLANEOUS  PEOBLEMS  257 

The  difficulty,  however,  is  that  in  order  to  see  and 
be  able  to  appreciate  and  have  some  understanding 
of  all  these  wonders  and  beauties  that  surround  us 
on  every  hand  that  it  is  necessary  to  do  some  study- 
ing, to  read  scientific  books,  go  to  lectures,  in  short 
to  work.  "Aye,  there's  the  rub,"  for  work  is  just 
exactly  the  thing  all  these  idlers  are  trying  to  escape 
from.  Work  means  expenditure  of  energy,  continu- 
ity of  effort,  contact  with  reality,  overcoming  of  ob- 
stacles, progress.  Idleness,  on  the  other  hand,  gives 
opportunity  for  phantasying,  for  day  dreaming  and 
air  castle  building,  in  short  affords  the  opportunity 
for  reverting  to  the  childish  ways  of  gaining  pleas- 
ure and  conquering  the  world  which  should  have  been 
renounced.  In  this  way  the  bad  habit  of  dreaming 
through  life  is  started  until  finally  the  victims  are 
quite  unable  to  bring  themselves  to  any  useful  kind 
of  exertion.  Unfortunately  too  there  goes  along 
with  this  tendency  the  tendency  to  criticize  others 
(a  projected  self-criticism),  a  tendency  to  see  in 
work  an  imposition  by  someone  else  rather  than  as 
a  glorious  opportunity  for  self-expression.  How 
many  people  have  wasted  fine  opportunities  and 
perhaps  exceptional  endowments  in  fussing  because 
someone  was  paid  a  little  more  or  given  a  few  more 
privileges  than  they  were  when  if  they  had  attended 
to  their  work  they  might  easily  have  risen  to  the  top 
of  their  profession  when  every  emolument  would 
have  been  theirs. 

What  all  these  people  need  is  the  power  to  love, 


258  MENTAL  HYGIENE 

using  love  in  the  broad  sense  of  unreserved  giving, 
be  it  to  a  person,  a  task,  an  ideal.  Of  love  HalP 
writes,  "Only  when  we  have  found  some  cause  or 
end  that  so  transcends  self  that  love  and  loyalty  to 
it  would  certainly  prompt  us  upon  emergency  to  face 
the  Great  Terror  in  his  most  hideous  form,  has  the 
true  life  of  the  race  begun  consciously  in  us.  Only 
then  are  we  complete  men  and  women.  Only  then 
have  we  attained  the  true  majority  of  humanity,  and 
are  we  rightly  oriented  in  a  moral  universe.  Thus 
alone  we  can  take  the  first  conscious  step  toward  en- 
tering the  Kingdom.  This  muse  of  death  is  not  that 
of  Stoic  philosophic  resignation  to  the  inevitable, 
nor  is  it  the  blind,  instinctive  gregarious  impulse 
that  might  prompt  self-sacrifice  in  a  sudden  emer- 
gency. It  is  a  higher,  full-blown  consciousness  of 
what  life  means,  of  man's  place  in  his  world,  and  his 
duties  to  it." 

Love  in  this  sense  is  life  and  the  idleness  which 
spends  itself  in  wishing  rather  than  doing  is  death. 

OLtD  AGE^ — DEATH 

In  the  natural  course  of  events  old  age  and  death 
close  the  story  in  each  individual  case.  Even  this, 
however,  like  all  other  statements,  needs  qualifica- 
tion. Age,  as  I  have  already  shown,  is  a  relative 
term.  *' Forty  is  the  old  age  of  youth;  fifty  is  the 
youth  of  old  age."  *     Such  a  statement  as  this,  how- 

3  Hall,  G.  Stanley:  "Jesus,  The  Christ,  in  the  Light  of  Psychology." 
Doubleday,  Page  &  Co.,  New  York,  1917. 

4  Victor  Hugo. 


MISCELLANEOUS  PROBLEMS  259 

ever,  only  shows  one  aspect  of  age  other  than  those 
which  I  have  already  covered.  From  the  psycholog- 
ical aspect  it  would  seem  that  age  may  be  considered 
in  terms  of  mental  crystallization,  of  incapacity  to 
further  progress  along  the  path  of  increasingly  com- 
plex adaptations,  of  loss  of  ability  to  acquire  new 
material,  failure  of  capacity  to  learn,  to  take  in  more 
experience  and  assimilate  it. 

In  this  slow  process  of  mental  crystallization  and 
loss  of  capacity  for  acquiring  new  ideas  we  see  the 
outward  evidences  of  what  is  fundamental  in  getting 
old.  Age,  as  I  have  shown,  is  not  a  matter  of  years 
but  a  matter  of  having  lived.  It  comes  slowly  at  first 
and  then  with  quickened  pace  as  the  material  of  ex- 
perience accumulates,  in  short  it  is  a  process  which 
is  best  described  as  an  accumulation  of  our  past. 

We  live  our  lives  out  along  certain  lines  of  en- 
deavour which  become  more  and  more  definite  as  the 
years  go  by,  and,  correspondingly,  as  our  way  of 
living  becomes  more  definite  it  becomes  more  diffi- 
cult to  change  it,  readjust  to  new  demands  because 
the  inertia  of  an  ever  increasing  past,  filled  with  ac- 
quired habits  and  points  of  view,  makes  it  more  and 
more  impossible. 

Along  with  this  settling  into  fixed  grooves,  how- 
ever, comes  a  consciousness  of  obstacles  overcome 
on  the  way^  and  a  feeling  of  security  bom  of  the 
ability  acquired  through  long  years  of  experience. 
With  the  decline  of  the  insistent  urge  of  the  passions 
life  seems  to  emerge  from  a  whirlpool  of  conflicting 

5  Old  Age.     Emerson. 


260  MENTAL  HYGIENE 

tendencies  into  a  clear,  smooth  eddy  of  calm  repose, 
and  with  the  dulling  of  the  keen  zest  for  life  comes 
a  growing  kindliness  and  benevolence.  In  propor- 
tion as  a  man  has  lived  broadly  and  deeply  unham- 
pered by  the  infantile  neurotic  fixations  which  have 
interfered  with  his  development  along  restricted 
lines,  in  proportion  as  he  has  experienced  life  to  the 
full  in  all  its  varied  manifestations,  its  griefs  as 
well  as  its  joys,  in  proportion  as  he  has  succeeded  in 
fully  expressing,  so  to  speak,  emptying  himself,  he 
will  approach  the  end  calmly,  the  desire  to  live  grad- 
ually slipping  away  until  he  passes  from  life  with 
as  little  consciousness  as  he  was  born  into  it.  This 
is  as  it  should  be.  The  pathology  of  old  age  natur- 
ally can  not  be  discussed  here. 

But  how  does  death  come  about?  The  monocellu- 
lar microorganisms  are,  practically  speaking,  im- 
mortal; death  is  an  attribute  that  only  belongs  to 
more  highly  organized  beings.  Death,  as  a  matter 
of  fact,  is  an  acquired  character  which  has  been  de- 
veloped in  the  course  of  evolution  because  of  its 
value  to  the  race.    But  howl 

I  have  spoken  of  age  as  an  accumulation  of  past 
and  indicated  how  this  past  finally  clogs  further 
progress.  In  some  way  then  the  past  has  to  be  got- 
ten rid  of,  ** sloughed  off"  as  Hall  would  say.  Not 
only  all  that  obviously  interferes  with  progress  may 
be  traced  to  an  accumulated  past  but  less  obvious 
moral  qualities,  even  sin  itself  can  likewise  be  so 
considered.  All  so-called  ''wrong"  conduct  can  be 
shown  to  belong  to  types  which  at  one  time  in  the 


MISCELLANEOUS  PROBLEMS  261 

cultural  history  of  mankind  were  considered 
''right"  ways  of  acting. 

Death,  therefore,  can  be  seen  to  be  inevitable  be- 
cause the  constantly  accumulating  past  clogs  the 
machine  more  and  more  until  finally  life  itself  be- 
comes impossible.  But  if  that  were  all  death  would 
have  no  meaning.  To  serve  its  purpose  to  the  race 
it  must  be  necessary  that  in  dying  man  should  be 
able  to  rise.  Phoenix  like,  from  his  ashes  and  reborn, 
take  up  again  the  life  of  the  race. 

This  is  precisely  what  happens.  The  germ  plasm 
has  all  the  properties  of  perennial  youth  of  the 
monocellular  organism.  It  is  the  soma  which  re- 
sponds to  the  complex  environment  by  an  ever  in- 
creasing specialization  of  its  several  parts  until,  like 
the  balance  of  power  in  Europe,  things  can  go  no 
further.  It  is  then  that  the  soma  dies  but  the  germ 
plasm,  protected  from  the  very  first  from  the  neces- 
sity of  specialization,  lives  on  and  carries  forward 
the  life  of  the  race. 

Life  and  death,  therefore,  can  be  seen  to  be  but 
reciprocal  aspects  of  the  same  process  of  progress- 
ive development.  Without  one  the  other  could  not 
be  and  death  is  as  necessary  for  life  as  life  is  for 
death.  If  we  could  view  this  earth  from  some  far 
distant  point  in  space  as  did  Queen  Mab  ^  until  it 
seemed  ''the  smallest  light  that  twinkles  in  the 
heavens"  then  perhaps  the  horror  of  this  great 
world  war  would  sink  into  its  proper  perspective  and 
we  would  see  that  this  great  struggle  was  born  of 

6  Shelley. 


262  MENTAL  HYGIENE 

the  dire  necessity  of  destroying  the  baleful  influence 
of  an  accumulated  past  which  blocked  effectually 
further  progress  and  then  we  would  understand  that 
after  all  perhaps  it  was  all  for  the  best  and  the  world 
would  emerge  with  a  new  impetus  to  growth  for: 
''One  generation  passeth  away  and  another  genera- 
tion Cometh ;  but  the  earth  abideth  forever.  The  sun 
also  ariseth,  and  the  sun  goeth  down,  and  hasteth  to 
his  place  where  he  arose.  The  wind  goeth  toward 
the  south,  and  turneth  about  unto  the  north;  it 
whirleth  about  continually,  and  the  wind  returneth 
again  according  to  his  circuits.  All  the  rivers  run 
into  the  sea;  yet  the  sea  is  not  full;  unto  the  place 
from  whence  the  rivers  come,  thither  they  return 
again. ' '  '^ 

1  Eeclesiastes  i,  4,  5,  6,  7. 


CHAPTER  IX 
THE  NEUROSES— PSYCHOANALYSIS 

We  now  come  to  the  consideration  of  a  host  of, 
relatively  speaking,  minor  maladjustments.  The 
large  groups  already  considered  are  definitely  recog- 
nized by  the  herd  because  they  involve  conduct  dis- 
orders which  are  more  or  less  directly  and  more 
or  less  seriously  antisocial.  The  neuroses,  on  the 
other  hand,  usually  exist  without  attracting  the  at- 
tention of  the  herd  at  all  because  they  either  result 
in  lessened  activities,  or  such  anomalous  forms  of 
conduct  as  are  not  seen  to  have  social  significance, 
or,  not  infrequently,  because  they  exist  in  persons  of 
considerable  efficiency  and  often  of  great  social 
value. 

The  neuroses  comprise  a  large  group  of  disorders, 
expressed  at  the  psychological  level  of  reaction, 
which  are  difficult  if  not  impossible  to  define  but 
which  consist  of  a  wide  variety  of  depressions,  fears, 
apprehensions,  anxieties,  time  consuming  ceremo- 
nials, fixed  habits,  impulsive  activities,  stereotyped 
forms  of  conduct  and  a  thousand  and  one  other  mani- 
festations all  of  which  are  energy  consuming  and  so 
involve  a  lessening  in  the  amount  of  energy  avail- 
able for  useful  purposes.  They  lead  to  almost  unbe- 
lievable amounts  of  suffering  not  only  on  the  part 

263 


264  MENTAL  HYGIENE 

of  the  afflicted  person  but  quite  generally  of  others 
in  his  immediate  environment  and  also  to  a  tre- 
mendous wastage  of  energy. 

This  book  is  of  course  not  the  place  for  a  detailed 
discussion  of  the  neuroses.  The  reader  must  refer 
to  special  works  for  such  information.^  It  will  be 
of  advantage,  however,  to  briefly  outline  the  indi- 
vidual psychical  development  and  the  broad  prin- 
ciples of  treatment  of  disorders  in  this  region,  not 
only  because  this  is  a  work  dealing  with  the  prin- 
ciples of  mental  hygiene,  but  because  in  the  orderly 
development  of  the  subject  it  would  appear  to  belong 
here. 

In  the  chapters  II  and  III  on  Underlying  Concepts 
and  Mental  Mechanisms  I  developed  the  psycholog- 
ical approach  to  the  various  problems.  I  subse- 
quently applied  these  mechanisms  in  the  considera- 
tion of  the  several  problems  with  sufficient  thorough- 
ness, I  believed  to  serve  in  aiding  the  reader  to  com- 
prehend them  from  the  point  of  view  from  which  I 
presented  and  discussed  them.  In  dealing  with 
these  minor  maladjustments,  however,  it  is  no  longer 
of  much  help  to  rest  in  such  general  statements  while 
the  neuroses  themselves  offer  admirable  material 
for  the  illustration  of  the  deeper  lying  mechanisms  ^ 
some  understanding  of  which  is  essential  in  order 
that  a  true  comprehension  of  the  meaning  of  mental 
hygiene  may  be  had. 

1  See  especially  JelliflFe  and  White :  "Diseases  of  the  Nervous  Sys- 
tem."   Lea  &  Febiger,  Philadelphia,  1917. 

2  For  a  fuller  discussion  of  these  mechanisms  the  reader  is  referred 
to  my  "Mechanisms  of  Character  Formation." 


THE  NEUROSES  265 

I  have  briefly  indicated,  in  the  first  two  chapters, 
the  tremendous  heritage  from  the  past  that  each  one 
of  us  brings  into  the  world  and  with  which  we  start 
the  battle  of  life.  This  is  a  heritage  of  500,000  years 
as  humans  alone,  to  say  nothing  of  the  millions  of 
years  back  of  that  during  which  the  simplest  mono- 
cellular structures  were  evolving  into  and  through 
the  metazoa  to  their  present-day  goal  in  man.  It 
must  be  true,  therefore,  and  a  little  reflection  will 
serve  to  convince  us  that  it  is,  that  the  various  in- 
dividuals of  the  human  species — homo  sapiens — are 
vastly  more  alike  than  different,  that  they  have, 
literally,  thousands  of  points  of  resemblance  to  one 
of  difference.  It  must  also  be  perfectly  plain  that 
such  points  of  dissimilarity  as  exist  must  have  refer- 
ence, in  the  main,  only  to  that  relatively  infinitesimal 
part  of  us  which  belongs  to  us  individually,  which  is 
the  product  of  our  individual  rather  than  our  racial 
development. 

In  the  discussion  of  Mental  Mechanisms  (Chap. 
Ill)  I  have  shown  how  this  tremendous  past,  so  far 
as  it  concerns  the  psyche,  constitutes  the  unconscious 
and  how  the  unconscious  is  added  to  in  each  individ- 
ual life  by  the  accumulation  of  all  the  psychic  mate- 
rial which  has  been  lived  past  and  lived  through  so 
that  as  soon  as  a  psychic  reaction  has  served  its  pur- 
pose, it  sinks  into  the  region  of  the  unconscious,  and 
as  an  added  bit  of  acquired  efficiency  becomes  a  new 
resting  place  for  further  superstructures. 

The  psyche,  quite  like  the  body,  recapitulates  the 
past,  both  individual  and  racial,  in  its  development. 


266  MENTAL  HYGIENE 

If  this  recapitulation  be  compared  to  the  stratifica- 
tions of  the  earth  crust,  as  does  Jelliffe,  then  it  is 
possible  to  refer  symptoms  of  maladjustment  as 
they  occur  at  the  psychological  level — mental  dis- 
ease— to  definite  strata  in  the  history  of  the  indi- 
vidual. In  the  same  way  we  can  speak  of  certain 
types  of  maladjustment  as  being  characteristic  of 
certain  strata  of  development  just  as  certain  fossils 
are  characteristic  of  certain  geological  strata.  Of 
course  this  is  all  somewhat  hypothetical  because  the 
psychic  development  has  not  been  worked  out  with 
a  degree  of  thoroughness  anything  like  sufiicient  to 
enable  us  to  do  this  in  any  detail  but  the  broad  gen- 
eral lines  have  been  laid  down  and  so  far  as  they  are 
clear  the  principle  applies. 

I  shall  try,  in  this  Chapter,  to  supplement  what  I 
said  of  mental  mechanisms  in  Chap.  Ill  and  to  elab- 
orate that  discussion  sufficiently  to  make  under- 
standable those  relatively  more  superficial,  and  con- 
tinuing the  geological  figure,  recent  disturbances  of 
adjustment  comprised  under  the  classification  of  the 
neuroses.  In  this  way  I  shall  have  covered  the  dis- 
orders of  the  mind  all  the  way  from  the  most  deep 
seated  of  biological  types  of  failure  to  those  defects 
which  depart  only  in  minor  degree  from  the  normal. 
I  have  pursued  what  may  seem  to  be  the  reverse  of 
a  logical  order  but  I  did  so  because  the  wider  de- 
partures from  the  normal  are  more  easily  appreci- 
ated as  such  while  the  lesser  degrees  are  more  diffi- 
cult to  understand  unless  approached  with  the  knowl- 
edge gained  from  more  serious  situations.    From 


THE  NEUROSES  267 

the  point  of  view  gained  in  this  chapter  it  would  be 
well  to  reconsider  the  problems  discussed  in  Chap- 
ters IV,  V,  VI,  VII,  and  VIII.  This  I  shall  do, 
briefly,  in  the  next  chapter. 

CHAEACTEE  ANOMALIES 

To  illustrate  how  a  child  may  suffer  in  the  devel- 
opment of  its  character  from  a  fixation  in  the  family 
situation,  that  is,  from  an  inability  to  give  up  its 
childish  pleasure  in  dependence  upon  the  family  and 
go  out  into  the  world  and  establish  its  independence 
I  will  outline  a  hypothetical  case.  A  boy,  for  in- 
stance, has  an  illness  when  very  young,  which  for  a 
time  at  least  incapacitates  him  and  puts  him  at  a 
disadvantage  in  his  activities  as  compared  with  the 
other  boys,  so  that  he  is  not  capable  of  measuring  up 
in  efficiency  with  them  in  athletic  sports,  etc.,  so  that 
he  constantly  has  to  forego  certain  kinds  of  pleas- 
ure, for  example,  swimming,  running  or  baseball, — 
all  of  these  things  make  him  the  object  of  solicitude 
and  tenderness  on  the  part  of  the  parents.  This 
solicitude  and  this  tenderness  very  easily  become 
things  to  be  desired  in  themselves,  so  that  the  boy 
becomes  perhaps  the  cry-baby  of  the  family  in  his 
efforts  at  seeking  this  affection,  because  oftentimes 
the  parents  will  give  him  something  that  he  likes 
very  much  because  he  cannot  enter  into  some  par- 
ticular sport, — give  him  some  candy  or  some  cake  or 
take  him  to  the  theatre  or  do  something  of  that  sort 
to  repay  him  for  what  he  is  losing  in  other  direc- 
tions    This  relationship  to  the  family,  it  can  be 


268  MENTAL  HYGIENE 

easily  seen,  softens  the  boy,  so  to  speak, — may  easily 
make  him  altogether  too  tender  to  bear  the  average 
difficulties  of  life,  so  that  when  he  grows  up  he  is 
quite  incapable  of  adjusting  to  the  rough  treatment 
that  reality  ordinarily  gives  us.  He  may  become 
wholly  inefficient,  quite  incapable  of  leaving  the 
home  and  going  out  into  the  world  at  all,  and  sim- 
ply remain  a  child  in  the  household,  cared  for  by  the 
parents,  supported,  looked  after,  as  he  always  had 
been  in  his  infancy,  in  which  case  he  not  infrequently 
makes  spasmodic  efforts  to  break  away  from  the 
control  of  the  parents,  and  perhaps,  at  such  times 
curses  them  and  is  abusive  and  blames  them  for  his 
invalidism.  This  is  not  an  uncommon  picture.  On 
the  other  hand,  he  may  go  out  into  the  world  and  be 
quite  efficient  but  be  thin-skinned  and  very  easily 
hurt  at  all  kinds  of  critcism,  or  again,  be  extremely 
irritable  and  impatient  in  the  face  of  any  sort  of  re- 
sistance or  difficulty  and  be  so  disagreeable  that 
hardly  anyone  can  get  along  with  him.  He  is  accus- 
tomed to  having  had  his  ways  made  smooth, — he 
cannot  stand  life  when  it  is  rough  So  that  all  these 
defects  of  character  are  traceable  to  what  has  been 
called  a  fixation  at  a  certain  point  in  the  develop- 
ment of  the  individual,  in  this  case  a  fixation  in  de- 
pendence on  the  family,  dependence  upon  too  great 
an  exhibition  of  tenderness  upon  the  part  of  the  par- 
ents, which  while  it  was  brought  about  in  this  case 
through  the  physical  illness  of  the  child,  it  will  be 
understood  is  the  sort  of  danger  to  which  any  child, 
particularly  an  only  child,  may  be  exposed  irrespec- 


THE  NEUROSES  269 

tive  of  physical  illness.  I  think  all  are  familiar  with 
instances  of  this  sort.  Such  a  person,  when  he  mar- 
ries, will  be  pretty  apt  to  pick  out  a  woman  that  re- 
sembles his  infantile  image  of  his  mother.  He  will 
marry,  not  as  adults  should  marry,  in  order  to  join 
their  lives  to  a  partner  with  whom  they  expect  to 
meet  the  problems  of  life  in  a  more  efficient  manner 
because  of  mutual  understanding  and  helpfulness, 
but  he  will  marry  a  woman  in  whom  he  sees  again 
his  mother,  in  order  to  regain  the  lost  pleasures 
which  he  has  always  missed  since  he  was  separated 
from  her,  perhaps  by  her  death,  and  so  he  carries  his 
weakness  along  with  him  into  his  adult  life,  and  his 
inefficiency  in  all  sorts  of  ways  can  be  traced  to  it. 

A  quite  similar  crippling  is  brought  about  in  a 
different  way.  In  those  cases,  in  which  the  mother 
has  been  aggrieved,  perhaps  widowed  or  deserted, 
and  the  boy  is  the  only  child.  This  situation  results 
again  in  the  mother  devoting  too  much  tenderness 
to  the  child.  She  is  trying  to  gain  that  expression 
through  him  which  she  should  have  gained  in  other 
ways.  This,  too,  softens  the  boy,  robs  him  of  his 
virility. 

Let  me  take  another  type  of  inefficiency, — that 
mediated  by  the  boy's  relation  to  his  father: — Sup- 
pose the  father  had  been  a  very  overbearing,  perhaps 
a  cruel  father  and  husband, — suppose  in  his  domi- 
nation of  the  family  he  had  been  unreasonable,  arbi- 
trary to  the  last  degree,  and  had  perhaps  over  and 
over  again  during  the  early  years  of  the  child's  life, 
beaten  him,  sometimes  for  things  that  he  had  never 


270  MENTAL  HYGIENE 

done.  If  we  realize  that  the  father  normally  repre- 
sents authority  in  the  family  we  can  easily  see  how 
a  child  will  often  grow  up  to  hate  the  father  as  rep- 
resenting this  source  of  authority,  and  in  later  life 
will  continue  to  hate  all  sources  of  authority,  not 
only,  perhaps,  as  represented  in  the  heads  of  gov- 
ernments and  in  government  itself,  but  in  more 
subtle  ways  will  show  his  incapacity  for  fitting  into 
the  established  order  of  things.  He  will  always  be 
the  protestor,  the  rebel,  reformer,  agitator,  advocate 
of  new  ideas,  etc.  As  an  iconoclast  the  results  may 
be  unfortunate,  as  one  whose  respect  for  authority 
has  been  tempered,  so  that  he  is  not  blinded  by  mere 
statement  but  is  ever  ready  to  give  the  new  idea  a 
hearing,  the  quality  may  be  of  great  value. 

These  are  some  of  the  ways  in  which  people  fail 
to  live  at  their  best,  because  of  early  fixations,  be- 
cause of  defects  in  the  orderly  process  of  develop- 
ment at  some  point.  Let  us  look  at  the  problem 
from  a  little  different  angle : — 

CHARACTEK   TRAITS 

I  have  been  speaking,  up  to  this  time,  of  the  indi- 
vidual as  a  whole,  of  his  relations  to  his  parents,  for 
example.  It  will  be  remembered  what  I  said  about 
the  will  to  power,  about  the  desire  that  the  individual 
has  to  attain  to  the  maximation  of  his  ego;  it  is 
equally  true  of  every  portion  of  the  individual  that 
that  particular  portion  desires,  to  use  the  psycho- 
logical term,  to  attain  the  fullest  expression  of  its 
power.    Every  particular  component  of  the  indi- 


THE  NEUROSES  271 

vidual  is  striving  in  this  same  way  so  that  the  fin- 
ished product,  as  we  know  it,  is  only  a  bundle  of 
compromises  which  has  been  brought  about  by 
conflicts  between  all  these  various  tendencies.  Take 
one  of  these  tendencies,  for  example,  one  of  these 
that  we  may  call  partial  tendencies, — ^the  tendency 
to  domination,  which  shows  itself  so  frequently  in 
cruelty  in  the  relation  between  the  sexes,  and  which 
belongs  primarily  to  the  man: — this  tendency  to 
dominate  within  certain  limits  is  a  perfectly  normal 
one,  but  not  infrequently,  as  we  know  only  too  well 
through  the  annals  of  crime,  it  becomes  a  cruelty  ten- 
dency, and  we  have  developed  individuals  in  whom 
the  will  to  power  of  this  particular  tendency  has 
overshadowed  everything  else  in  their  character  and 
they  become  demons  unable  to  stand  any  opposition, 
going  about  injuring  and  killing, — they  are  the  wife- 
beaters  and  the  Jack-the-rippers  of  the  criminal  col- 
umns of  the  newspapers.  Now  what  happens  to  this 
tendency  when  it  expresses  itself  in  a  less  violent, 
in  a  less  pathological  form,  but  still  abnormally? 
We  find  people  who  are  always  saying  cutting  and 
mean  things  about  others;  we  find  people  who  are 
always  playing  vicious  tricks  upon  other  people  that 
hurt  them  in  one  way  or  another,  the  same  tendency, 
but  not  so  viciously  displayed.  The  tendency  again 
is  seen  undoubtedly  in  the  choice  of  certain  profes- 
sions. Efficiently  sublimated,  the  desire  and  capac- 
ity for  domination  express  themselves  in  the  capacity 
to  command  and  may  be  seen  at  work  in  captains  of 
industry,  military  commanders,  and  in  fact  wher- 


272  MENTAL  HYGIENE 

ever  power  to  command  is  strongly  in  evidence. 
Here  are  a  few  ramifications  of  this  particular  in- 
stinct. I  want  to  call  attention  to  one  special  feat- 
ure of  it,  however,  which  is  of  very  great  impor- 
tance. The  difference  between  this  cruelty  instinct, 
as  we  see  it  in  a  Jack-the-ripper,  and  as  we  see  it  in  a 
respectable  business  man  quietly  going  about  his 
work  and  being  a  useful  member  of  society,  is  that  in 
one  case  the  instinct  is  socialized,  or  as  the  psycho- 
analysts more  frequently  say,  sublimated,  and  in 
the  other  case  it  is  not.  In  one  case  it  has  been 
moulded  to  conform  with  the  social  requirements, — 
in  the  other  case  it  preserves  its  original  instinctive 
and  infantile  characters  in  opposition  to  those  re- 
quirements. Here  we  have  an  illustration,  a  most 
important  one,  an  illustration  of  the  socialization  of 
instinct,  the  process  by  which  all  development  is 
made  possible.  This  example  shows  how  it  is  possi- 
ble for  the  conflict  between  the  unconscious  and  the 
conscious,  between  the  instinctive  tendency  and  the 
social  requirements,  to  be  solved  by  satisfying  both 
demands.  The  higher  demands  of  the  social  re- 
quirements are  met  efficiently,  but  only  because  in 
meeting  them  the  individual  derives  a  certain  pleas- 
ure in  doing  so,  because  he  can  meet  them  in  a  way 
that  satisfies  his  unconscious  instincts,  because  the 
pleasure  both  of  the  instinct  and  of  the  social  re- 
quirements has  the  same  origin. 

This  principle,  namely,  that  the  conflict  can  only  be 
resolved  when  both  contending  factors  are  satisfied 
is  of  very  great  importance  and  has  great  possibili- 


THE  NEUROSES  273 

ties  of  application  to  practical  problems.  For  ex- 
ample, in  the  large  social  problems  which  are  now 
pressing  for  solution.  Take  for  instance  the  prob- 
lem of  labour  and  capital.  There  have  been  many  ef- 
forts to  keep  labour  satisfied  by  surrounding  the  la- 
bouring man  with  all  sorts  of  luxuries,  in  the  way  of 
club  houses,  gymnasiums,  libraries,  etc.,  etc.  When- 
ever these  means  have  taken  on  a  purely  paternalis- 
tic character  and  resolved  themselves  into  gifts  pure 
and  simple  the  labouring  man  has  felt  that  they  were 
merely  a  bribe  for  his  quiescence  and  has  never  had 
any  compunction  about  throwing  them  all  overboard 
in  contending  for  a  principle.  That  which  is  not 
earned  and  so  deserved  has  no  value.  Labour  and 
capital  are  not  concrete  entities  in  opposition  to  each 
other  but  the  opposite  terms  of  a  relation  and  no  so- 
lution of  their  difficulties  will  ever  be  a  true  solution 
which  does  not  equally  advantage  both  and  in  addi- 
tion raise  the  whole  relationship  to  a  higher  plane 
of  efficiency,  a  higher  level  of  social  value. 

SOCIALIZATION   OF   INSTINCTS 

It  is  this  socialization  of  our  instincts  which  is  the 
important  factor  in  our  psychological  development 
— the  development  of  what  has  been  aptly  termed  the 
herd  instinct.  Monocellular  organisms  are  to  all  in- 
tents and  purposes,  all-sufficient  unto  themselves. 
They  perform  all  of  the  functions  of  nutrition  and 
reproduction  without  relation  to  other  individuals 
of  their  species  and  they  are  practically  immortal — 
they  die  only  as  a  result  of  accident.    At  a  little 


274  MENTAL  HYGIENE 

later  stage  of  evolution  they  form  loosely  organized 
communities  in  whicti  we  can  already  see  a  beginning 
differentiation  of  the  component  cells  into  those 
which  perform  primarily  the  function  of  digestion, 
those  which  occupy  a  position  at  the  surface  and 
have 'to  feel  out,  so  to  speak,  the  environment,  and 
those  which  are  more  essentially  engaged  in  repro- 
duction. As  the  process  of  evolution  produces  still 
more  complex  animals  and  plants  this  specialization 
of  the  individual  cellular  components  continues  until 
in  the  highest  organism  we  find  cells  which,  like  the 
nerve  cells  of  the  higher  animals,  have  no  power  at 
all  to  live  except  as  component  parts  of  the  whole 
organism,  and  no  power  within  themselves  of  repro- 
duction. A  nerve  cell  once  dead  is  never  replaced. 
With  this  highly  developed  individuation  has  gone 
along  hand  in  hand  a  corresponding  renunciation  of 
immortality 

A  quite  analogous  process  is  seen  in  the  develop- 
ment of  human  society.  Primitive  man  is  relatively 
undifferentiated.  Each  individual  is  able  to  per- 
form the  functions  of  any  other  individual.  As  so- 
ciety became  more  complex  the  state  of  affairs 
changed  until  today  we  find  society  composed  of  a 
large  number  of  groups  each  performing  highly  spe- 
cialized functions,  which,  while  they  permit  of  the 
greatest  individual  development  and  efficiency,  are 
only  made  possible  because  of  the  relatively  subor- 
dinate role  which  they  play  to  society  as  a  whole. 
Abolish  the  social  group,  and  its  component  members 
would  at  once  have  to  revert  to  their  primitive  and 


THE  NEUROSES  275 

relatively  undifferentiated  forms  of  activity.  Thus 
we  see  in  the  process  of  evolution  a  tendency  which 
makes  for  the  ever  greater  development  of  the  indi- 
vidual, which  development,  however,  is  only  made 
possible  by  a  subordination  of  individual  aims  to  a 
larger  purpose, — the  welfare  of  the  group.  This  is 
the  process  of  the  socialization  of  our  instincts  which 
are  thus  seen  to  be  selfish  as  compared  with  the 
wider  interests  of  the  group.  Mankind  is  in  a  state 
of  ''auto-captivity"  as  has  been  well  said.  The 
self-sustaining,  self-aggrandizing  instincts  are  op- 
posed to  the  welfare  of  the  group  which  demands 
that  man  must  give  of  himself,  must  be  creative  and 
every  advance  towards  these  higher  social  aims  is 
accomplished  only  by  overcoming  great  opposition — 
resistance — on  the  part  of  the  individual,  who  in- 
stinctively clings  to  the  situation  with  which  he  is 
familiar. 

Now,  the  point  which  has  been  emphasized  by  psy- 
choanalysis, and  which  has  been  the  storm  centre  of 
the  criticism  directed  against  it,  is  that  the  motive 
power  which  keeps  man  from  socializing  his  in- 
stincts, the  basis  of  his  tendency  to  shirk  his  social 
obligations,  the  premium  offered  him  by  psychic  in- 
activity and  failure,  is  sexuality. '  It  is  impossible 
for  me,  in  such  a  book  as  this,  to  substantiate  this 
statement.^  I  can  only  say  that  the  evidence  indi- 
cates that  sex  gratification  seems  to  be  the  original 
mould  into  which,  in  their  ultimate  analysis,  all  other 

3  The  reader  is  referred  to  the  author's  "Mechanisms  of  Character 
Formation"  for  a  further  elaboration  of  this  subject. 


276  MENTAL  HYGIENE 

forms  of  gratification  fit,  it  is  the  final  measure  of  all 
forms  of  pleasure  whether  experienced  in  concrete 
sensations  or  in  the  highly  sublimated  forms  of  ex- 
pression of  the  creative  imagination.  In  its  last 
analysis  the  pleasure  component  founds  in  sex.  In 
other  words,  the  pleasure  of  the  pleasure  motive  for 
conduct  upon  being  reduced  to  its  ultimate  is  found 
to  be  identical  with  sex  pleasure.  Sexuality  is  the 
pleasure  premium  of  the  pleasure  motive. 

The  significance  of  this  if  true  is  very  great  and 
has  to  do  with  the  whole  problem  of  the  socialization 
of  our  instincts  in  a  most  intimate  way.  The  prob- 
lem at  basis  is  a  problem  in  energy  redistribution. 
Primitive  man,  like  the  child,  is  much  interested  in 
his  own  body,  his  own  sensations — he  is  ''auto- 
erotic."  He  wastes  enormous  amounts  of  energy  in 
concrete  sensuality,  energy  which  brings  no  benefits 
to  the  group.  The  process  of  civilization  has  as  one 
of  its  objects  the  deflection  of  this  energy  that  would 
otherwise  be  wasted,  from  sexuality  to  activities 
which  are  useful  to  the  herd — the  socialization  of  the 
energy  which  otherwise  would  flow  into  useless 
forms  of  instinct  gratification.  I  may  say,  paren- 
thetically, that  in  the  neuroses,  this  energy  is  still 
bound  up  to  infantile  sexual  ways  of  pleasure  seek- 
ing, that  is,  ways  which  in  the  course  of  individual 
development,  should  have  been  left  behind  as  having 
served  their  purpose  by  affording  steps  in  the  proc- 
ess of  attaining  adulthood,  and  the  object  of  psycho- 
analysis is  to  free  this  energy  so  bound  up  so  that 
it  may  be  employed  to  further  socially  useful  ends. 


THE  NEUROSES  277 

This  aspect  of  the  subject  of  psychoanalysis  has  been 
strangely  overlooked  by  the  critics. 

I  can  perhaps  illustrate  this  better  by  the  example 
of  the  nutritive  instinct.  In  the  old  days,  in  the 
Middle  Ages,  in  early  Eoman  times,  and  still  more 
prominently  among  primitive  men,  the  functions  of 
nutrition  were  carried  on  only  with  a  relatively 
great  waste  of  energy.  Food  was  not  taken  with 
anything  like  the  present  regularity,  periods  of  ac- 
tual want  alternated  with  periods  of  gluttonous 
over-indulgence.  The  food  itself  was  poorly  pre- 
pared, the  meat  often  raw  or  burned,  and  of  course 
much  more  frequently  than  in  these  days,  infected. 
It  thus  made  much  greater  demands  upon  the  diges- 
tive apparatus  than  does  now  our  well-prepared, 
well-cooked  and  regularly  served  nourishment.  All 
of  these  ways  of  wasting  energy  in  nutrition  have 
been  attacked  and  the  process  today  is  much  more 
economical  and  efficient,  so  that  the  energy  that  used 
to  leak  away  by  these  devious  paths  is  now  available 
for  something  else.  Whether  some  day  we  shall  de- 
velop this  process  to  such  a  high  state  of  efficiency 
that  we  shall  be  able  to  simply  take  an  occasional  tab- 
let and  go  on  with  our  work  I  do  not  know  but  there 
are  reasons  for  believing  that  this  will  not  be  so  be- 
cause of  the  considerable  tendency  which  eating  it- 
self has  shown  to  develop  and  to  take  on  social  ends. 
The  well  appointed  dinner  has  become  a  social  func- 
tion of  great  importance.  It  serves  as  the  meeting 
place  for  persons  allied  by  common  interests  and  also 
as  a  medium  for  enlarging  one's  social  contacts. 


278  MENTAL  HYGIENE 

The  dinner,  too,  is  not  infrequently  an  occasion  of 
great  significance  not  only  socially,  but  in  the  larger 
public  sense.  Affairs  of  state  are  not  infrequently 
born  on  such  occasions.  Without  going  further  with 
this  illustration,  I  may  add  that  the  waste,  conserva- 
tion, and  socialization  of  sexuality  parallels  that 
of  the  nutritional  development  and  in  their  failure 
we  recognize  the  sensualist  and  the  glutton  as  kin. 

The  way  in  which  this  bound-up  energy  is  freed 
is  by  the  process  known  as  sublimation.  I  have  al- 
ready illustrated  this.  Of  course  the  possible  illus- 
trations are  almost  infinite  for  they  include  every 
activity  of  man.  For  example,  according  to  this 
theory  the  curiosity  which  makes  a  man  a  scientist — 
let  us  say  a  micro scopist — is  traceable  to  that  early 
curiosity  in  looking — peeping — which  had  its  object 
in  seeing  forbidden  sexual  objects  or  acts.  The  im- 
mediate sexual  element  in  the  curiosity  is  sublimated 
into  a  socially  useful  purpose  to  which  the  original 
pleasure  is  still  attached  and  for  which  it  furnishes 
the  drive.  We  know,  too,  the  ''Peeping  Toms"  who 
still  show  this  same  form  of  pleasure  seeking  but 
have  been  unable  to  advance  their  way  of  obtaining 
pleasure  to  a  socially  acceptable  means. 

In  this  way  man  retains  the  pleasure  premium 
which  was  originally  attached  to  a  concretely  sexual 
motive,  for  application  to  an  end  which  has  value  for 
the  herd.  In  other  words,  it  is  only  when  there  is 
behind  a  given  activity  that  drive,  which  alone  sexu- 
ality can  furnish,  that  accomplishment  is  assured. 
We  can  understand  from  this  illustration  what  is 


THE  NEUROSES  279 

meant  by  the  saying  that  ''man  sexualizes  every- 
thing," the  truth  of  which  becomes  at  once  evident 
when  we  remember  the  fact  of  gender  as  an  attribute 
of  all  substantives.  This  becomes  still  more  evident 
in  languages,  in  which  the  gender  does  not  always 
seem  to  fit  accurately,  as  in  the  German  language,  or 
in  instances  which  do  not  seem  at  once  to  be  illustra- 
tive of  this  principle.  It  will  be  found  that  the  gen- 
der often  follows  less  superficial  but  still  quite  ob- 
vious resemblances.  A  few  examples  only: — Ani- 
mals which  are  essentially  aggressive  are  masculine, 
as  the  lion — the  king  of  beasts, — ^while  animals  which 
are  more  passive  and  graceful  are  feminine,  such  as 
the  cat.  The  ship  is  generally  feminine  because  of 
its  resemblance  to  the  pregnant  woman,  bearing 
the  life  within;  but  the  ship  built  for  fighting  is 
masculine — a  man-of-war.  Similarly  trees,  as  bear- 
ing fruit,  are  feminine.  Children  are  neuter  be- 
cause, as  yet,  their  sex  has  not  been  expressed. 
They  only  acquire  sex  later  in  life.  A  maiden  is 
thus  neuter  but  becomes  feminine  as  a  wife.  The 
pupil  because  of  its  resemblance  and  also  because  it 
is  receptive  is  feminine,  while  the  ear,  because  of  its 
receptive  function,  is  also  generally  used  as  a 
feminine  symbol,  and  in  French  is  of  the  feminine 
gender.  Let  me  only  add  in  passing  a  reminder 
of  the  Johannine  doctrine  of  the  Logos,  and  of  the 
large  literature  on  the  Immaculate  Conception  and 
the  doctrine  that  Mary  conceived  through  the  ears, 
a  theory  that  found  expression  in  medieval  art,  and 
in  the  hymns  that  referred  to  her  as  "Thou  who 


280  MENTAL  HYGIENE 

didst  conceive  through  the  ears."  This  concept  is, 
incidentally,  much  older  than  Christianity.  Of 
course,  these  illustrations  if  followed  up  would  be 
found  to  have  many  exceptions  but  these  again 
would  often  be  seen  to  have  fairly  obvious  reasons. 

Naturally,  if  the  theory  that  all  pleasure  found  in 
sex,  is  true,  we  might  expect  to  find  illustrations 
without  end  in  every  realm  of  human  endeavour. 
This  might  easily  be  done  but  it  is  not  my  purpose 
to  attempt  to  prove  the-  theory  in  this  place  but 
simply  to  state  it  and  give  sufficient  illustrations  so 
that  it  may  be  understood.  The  pragmatic  signifi-r 
cance  of  the  theory  is  that  man  is  constantly  sexualiz- 
ing  his  environment  in  order,  so  to  speak,  to  desex- 
ualize  himself,  to  the  extent  that  his  energy  is  bound 
up  in  infantile,  sexual  ways  of  pleasure  seeking,  and 
therefore  render  available  so  much  the  more  energy 
for  adult,  social  ends.  This  is  a  problem,  as  will 
be  seen,  in  efficiency  and  economy  in  which  the 
constant  effort  is  to  use  that  energy  which  would 
otherwise  be  dissipated  in  relatively  useless  forms 
of  activity  by  retaining  the  pleasure  premium  and 
attaching  it  to  higher  ends. 

A  few  illustrations  in  passing  to  help  clear  up 
what  may  otherwise  be,  I  fear,  rather  obscure. 
,There  are  two  ways  in  which  inefficiency  may  try  to 
avoid  reality — by  living  in  the  future  or  in  the 
past.  The  best  example  of  the  former  tendency  is 
offered  by  the  Middle  Ages,  a  period  in  which  the 
controlling  ideals  were  religious  and  the  present  life 
upon  earth  was  thought  of,  not  as  capable  of  being 


THE  NEUROSES  281 

made  a  valuable  thing  in  itself,  but  as  having  its 
only  worth  in  the  extent  to  which  it  contributed 
and  prepared  for  the  life  to  come.  Our  patients 
give  us  all  sorts  of  examples  of  their  attachment  to 
the  past.  One  of  my  patients  during  all  his  early 
life  found  it  almost  impossible  to  leave  his  home 
for  as  sure  as  he  did  he  was  made  ill  by  the  unac- 
customed food  and  had  to  return.  Another  could 
only  eat  the  food  he  had  learned  to  like  as  a  child. 
Another  engaged  passionately  in  the  study  of  the 
dead  languages  and  ancient  history.  Many  persons 
dress  or  talk  or  develop  the  mannerisms  of  a  par- 
ent and  not  infrequently  even  their  illnesses.  Those 
who  live  in  the  past,  seek  to  return  to  their  infan- 
tile dependence  upon  their  parents  and  thus  seek 
protection  from  the  burdens  imposed  by  reality. 
Those  who  only  live  in  the  future  may  only  lay  aside 
the  burden  because  Micawberwise,  they  are  sure  that 
^'something  will  turn  up,"  or  like  the  men  of  the 
Middle  Ages  they  project  their  infantilism  into  a 
Paradise  where  all  their  wishes  come  true  and  where 
they  find  again,  in  the  Holy  Family,  the  idealized 
parents  of  their  childhood.  In  either  case  the  in- 
dividual withdraws  his  energies  from  the  present 
task  and  to  that  extent  becomes  inefficient  in  deal- 
ing with  reality,  and  if  you  will  assume  with  me 
that  the  attachment  to  the  parents  has  a  sexual 
basis,  as  indicated  in  the  term  incest  complex,  you 
will  understand  what  I  mean  when  I  speak  of  re- 
nouncing infantile  pleasure  motives,  infantile  ways 
of  pleasure  seeking,  so  that  the  energy  bound  up 


282  MENTAL  HYGIENE 

in  such  activities  may  be  freed  for  socially  useful 
forms  of  conduct. 

The  story  then  would  read  something  like  this : — 
At  first  the  child  is  wholly  interested  in  his  own 
body,  is  auto-erotic.  By  an  immense  number  of  ex- 
periences in  coming  in  contact  with  reality  in  the 
shape  of  his  physical  environment  he  finally  suc- 
ceeds, though  not  fully,  in  differentiating  himself 
from  the  environment,  in  making  the  distinction  be- 
tween the  *'I"  and  the  "not-I."  When  he  has  got- 
ten the  process  well  under  way  he  finds  himself 
strongly  attached  in  his  love  to  the  members  that 
constitute  his  immediate  family  group.  This  is  the 
period  of  development  made  possible  by  his  depend- 
ence upon  the  family.  Finally  this  attachment,  too, 
has  to  be  given  up  so  that  he  may  come  to  find  an 
object  love  outside  the  family  and  found  his  own 
centre  of  influence  and  authority  with  others  in  like 
manner  dependent  upon  him.  His  growth  from  this 
point  continues  in  an  ever  widening  circle  as  he  is 
able  to  more  and  more  give  of  his  energy  to  the 
larger  social  group  and  extend  further  and  further 
his  influence  in  socially  useful  ways.  This  con- 
stant tendency,  from  this  point  of  view,  seems  to  re- 
sult in  a  constant  narrowing  of  the  individual  and 
a  corresponding  broadening  of  the  group,  but  this 
is  not  so;  it  furthers  itself  because  the  rewards 
which  come  to  the  individual  are  fully  equal  to  if 
not  much  greater  than  the  sacrifices  which  he  makes, 
so  that  as  a  matter  of  fact,  because  society  gives 
back  to  the  individual  quite  as  much  as  he  gives  it, 


THE  NEUROSES  283 

the  process  results  in  the  greatest  possible  develop- 
ment of  both  the  individual  and  the  group.  Man 
is  thus  free  only  when  he  conforms  to  law,  the  great- 
est freedom  being  commensurate  with  the  greatest 
conformity.  In  all  of  this,  of  course,  man  never 
quite  succeeds.  For,  paradoxically,  to  succeed 
would  be  to  fail.  The  tendency  is  continuously  to 
conserve  energy,  to  save  the  energy  wasted  and  to 
make  it  over  into  socially  useful  activities.  The 
old,  deeply  channelled  pathway  of  the  concrete  sex- 
ual must  always,  however,  be  left  open.  The  com- 
pleted love  story  will  always  remain  as  the  basic 
ideal  for  the  relation  of  the  sexes,  out  of  which  will 
,grow  the  highest  values  both  individual  and  social. 
So  in  our  neurotics  we  find  that  when  life  presents 
an  insurmountable  obstacle  and  they  are  driven  back 
from  the  pathway  that  leads  into  reality,  they  are 
more  easily  able  to  regressively  reanimate,  in  this 
old  pathway  of  least  resistance,  infantile  ways  of 
pleasure  seeking,  but  at  the  expense  of  tying  up  their 
energies  with  auto-erotic,  that  is,  selfish  modes  of 
■expression.  Psychoanalysis  tries  to  free  the  energy 
thus  bound  up  with  infantile  sexuality  for  socially 
useful  ends. 

ANIMISM 

I  have  illustrated  how  defects  in  character 
make-up  result  from  early  infantile  experiences 
which  fix  emotional  types  of  expression  of  the  in- 
dividual and  thus  tend  to  keep  him,  in  this  respect, 
infantile.    This  will  be  recognized  as  a  failure  to 


284  MENTAL  HYGIENE 

grow  up,  or,  as  expressed  in  Chapter  III,  as  the  in- 
stinct for  the  familiar,  or  the  safety  motive  for 
conduct. 

In  the  early  part  of  this  chapter  I  have  compared 
the  different  periods  of  psychic  development  to  the 
geologic  strata  of  the  earth's  crust.  One  of  the 
strata  which  I  have  already  mentioned  is  the  period 
of  animism  which  is  common  to  the  child  and  to 
primitive  man.  It  not  infrequently  outcrops  in  the 
adult  apart  from  severe  mental  crippling  and  is  com- 
monly in  evidence  in  the  psychoses.  I  have  given 
illustrations  of  this  animistic  type  of  reaction  in 
Chap.  III. 

THE   ORGANIC   BASIS   OF   MALADJUSTMENT 

I  have  already  said  that  it  is  as  true  of  the  parts 
of  an  individual  as  it  is  true  of  the  individual  as  a 
whole,  that  they  are  each  striving  after  the  fullest 
power,  the  greatest  sum  of  expression.  This  state- 
ment is  equally  true  of  the  several  organs  of  the 
body.  From  the  point  of  view  of  the  liver  the  body 
should  be  dominated  by  liver,  not  central  nervous 
system,  and  would  if  the  liver  could  have  its  way. 
The  orderly  growth  and  development  of  the  indi- 
vidual is  conditioned  by  a  balance  of  power  which 
insures  that  each  part  shall  develop  just  to  that  de- 
gree which  will  best  serve  the  purposes  of  the  whole. 

All  along  the  biological  pathway  progress  has  only 
been  possible  because  each  unit,  besides  preserving 
its  own  integrity,  has  been  willing,  so  to  speak,  to 
give  something  to  the  larger  unit  of  which  it  formed 


THE  NEUROSES  285 

a  part.  Each  cell  besides  preserving  its  own  life 
must  give  up  part  of  its  activities  to  help  in  the  ac- 
tivities of  the  organ  of  which  it  is  a  part,  the  organ 
must  do  likewise  with  respect  to  the  larger  unit,  the 
individual,  and  the  individual  must  repeat  the  pro- 
cess as  a  member  of  Society — the  herd.  The  liver, 
for  example,  besides  preserving  itself  as  liver  stores 
up  glycogen  to  be  used  by  the  muscles  when  the  indi- 
vidual is  in  danger,  and  gives  of  this  store  for  the 
larger  whole ;  the  man  pays  his  taxes  and  similarly 
helps  the  problems  of  society  of  which  he  is  an  inte- 
gral part.  It  thus  comes  about  that  in  the  process 
of  the  successive  integrations  to  progressively  larger 
ends  what  we  call  personality,  character,  issues  as  an 
end  result  but  depending  upon  all  these  bodily  pro- 
cesses which  underly  it.  Therefore,  according  to 
Adler,  character  traits  ultimately  are  reducible  to 
terms  of  organic  structure,  and  so  defects  of  char- 
acter depend  upon  organ  inferiority. 

If  the  tendencies  of  the  individual  as  a  whole,  that 
is,  all  of  his  energies,  be  called  by  a  single  name  we 
may  use  the  term  libido,  then,  the  implication  from 
what  has  been  said  thus  far  is  that  a  given  individual 
may  retain  evidences  of  his  infancy  only  in  certain 
zones  of  his  conduct,  his  gastro-intestinal,  mouth, 
ear,  eye,  skin,  genital.  These  then  would  be  called 
partial  libido  trends,  or  strivings. 

The  Adlerian  concept  would  substitute  for  the 
Freudian  theory  of  libido  fixation  as  an  explanation 
for  a  given  defect  of  character  the  theory  of  an  in- 
ferior organ.    He  believes  that  an  inferior  organ 


286  MENTAL  HYGIENE 

gives  a  sense  of  insecurity,  inferiority,  against  whicli 
the  neurotic  tries  to  protect  himself  by  so  ordering 
his  life,  so  regulating  his  every  act  that  he  may  find 
that  security  of  which  the  feeling  of  inferiority  has 
robbed  him.  This  effort  to  find  security  is  the  ficti- 
tious goal  of  the  neurotic  who  fails  in  attaining  the 
maximation  of  his  ego  because  his  efforts  are  di- 
rected along  this  false  path.  He  is  not  free  to  deal 
with  reality  at  his  best,  but  must  always  subordinate 
the  demands  of  reality  to  the  inner  need  of  satisfy- 
ing his  craving  for  security.  The  neurosis  or  psy- 
chosis is  therefore  a  constructive  creation,  a  compro- 
mise, a  compensation  product,  which,  however,  fails 
because  of  its  false  direction.  His  theory  summed 
up  in  a  few  words  reads :  The  neurotic  constitution 
founds  in  an  inferior  organ ;  the  inferior  organ  pro- 
duces a  feeling  of  inferiority ;  the  feeling  of  inferior- 
ity creates  the  fictitious  goal  of  the  neurotic,  whose 
symptoms  result  from  an  effort  to  mould  reality 
along  the  false  pathway  that  leads  to  safety. 

Let  me  give  an  example  of  such  infantile  and 
asocial  ways  of  using,  let  us  say,  the  ear  libido.  The 
type  of  person  is  well  known  who  is  always  listening 
to  hear  scandal  of  his  associates.  You  know  Avhat  a 
despicable  type  of  individual  such  a  person  is  from 
the  standpoint  of  the  usual  social  evaluation.  He 
does  not  listen  to  hear  something  good  but  always  to 
hear  something  bad,  and  the  worse  the  better.  This 
is  a  somewhat  less  obvious  pleasure  seeking  device 
than  that  of  the  person  who  is  all  attention  at  the 


THE  NEUROSES  287 

telling  of  every  obscene  story,  but  the  principle  is 
the  same  because  it  is  the  obscene  that  he  is  really 
listening  for.  Such  a  person  is  a  peddler  of  gossip, 
a  besmircher  of  reputations  and  in  all  sorts  of 
ways,  at  the  level  of  ear  libido  (listening)  an  asocial, 
destructive  member  of  the  community  and  incident- 
ally a  very  unhappy  and  unfulfilled  person  himself. 
As  far  as  his  function  of  hearing  is  concerned  he  has 
not  grown  up.  He  is  still  using  his  ear  to  minister 
to  a  low  level  type  of  curiosity.  His  ear  (sense  of 
hearing)  has  not  been  adequately  integrated  as  a 
part  of  a  socially  useful  member  of  society,  and 
therefore  is  not  used  to  further  socially  useful,  con- 
structive ends.  It  remains  at  the  instinctive,  pleas- 
ure seeking  level.  How  much  better  he  could  use  his 
proclivity  to  listen  by  going  to  lectures,  readings, 
concerts  and  thus  socializing  his  trend  by  using  it 
for  bringing  him  into  contact  with  his  fellows  at 
socially  useful  levels? 

From  this  point  of  view  the  organ  of  hearing  is 
conceived  of  as  inferior  (often  at  least  demon- 
strable) but  we  would  expect  our  listener  to  feel  a 
sense  of  inferiority  which  would  manifest  itself  in 
the  zone  of  ear  libido.  We  might  expect  him  to  feel 
frightened,  for  example,  if  he  was  unable  to  hear 
what  people  were  saying  and  consequently  to  feel 
that  they  might  have  been  saying  something  about 
him,  something  not  pleasant  of  course,  hatching  up  a 
plot  to  injure  him  or  the  like.  The  picture  is  fa- 
miliar enough  and  at  the  pathological  level  gives  us 


288  MENTAL  HYGIENE 

at  once  the  suggestion  of  the  paranoiac  with  his  hal- 
lucinations of  hearing  and  his  delusions  of  persecu- 
tion. 

The  inferior  organ,  in  this  case  the  organ  of  hear- 
ing, can  therefore  be  seen  to  be  asocial  in  its  tenden- 
cies because  it  hangs  on  to  infantile  ways  of  pleas- 
ure-seeking which  should  be  abandoned  as  the  indi- 
vidual grows  to  adulthood  in  favour  of  activities  that 
minister  more  to  the  larger  good.  The  individual, 
after  all,  can  only  include  what  is  under  central  con- 
trol, the  dynamic  or  metabolic  gradient,  Child  calls 
it*  speaking  of  the  physiological  individual.  A 
group  of  cells  may  establish  their  own  independent 
gradient  and  so  break  off  from  the  main  body  and 
set  up  a  goverimient  for  themselves.  This  we  rec- 
ognize as  one  of  the  determiners  of  tumour  forma- 
tion. A  similar  independence  at  the  psychological 
level  makes  the  individual,  in  the  particular  region 
involved,  asocial.  Asocial  conduct  may  therefore 
found  in  organ  inferiority. 

PSYCHOANALYSIS 

Psychoanalysis  had  its  origin  in  an  effort  to 
help  sick  individuals.  Unlike  academic  psychology, 
which  for  a  generation  had  been  dealing  with  arti- 
ficial human  beings  created  in  the  laboratory,  and 
before  that  with  metaphysical  problems,  psychoan- 
alysis from  the  first  was  confronted  with  the  prob- 
lems growing  out  of  actual  human  situations  taken 

4  Child,  C.  M. :  "The  Basis  of  Physiological  Individuality  in  Or- 
ganisms," Science,  April  14,  1916. 


PSYCHOANALYSIS  289 

from  life  as  real  human  beings  really  live  it  and 
know  it  and  so  was  intensely  humanistic  from  the 
very  first. 

Psychoanalysis  is  just  what  the  word  signifies, — 
it  is  an  analysis  of  the  psyche,  a  pulling  apart,  a  dis- 
section of  the  human  soul  for  the  purpose  of  finding 
out  of  what  it  is  composed.  This  process  of  dissec- 
tion or  analysis  is  the  way  in  which  facts  have  to  he 
wrested  from  nature,  for  she  does  not  disclose  them 
easily, — they  must  literally  be  torn  from  her.  No 
matter  how  beautiful  the  flower,  if  we  wish  to  know 
its  structure  it  must  first  be  torn  apart,  and  that 
which  appealed  to  us  as  beauty  be  destroyed  albeit 
to  reach  the  knowledge  of  a  greater  beauty  in  the 
wonders  so  disclosed.  To  the  uninitiated,  the  dis- 
membered flower  is  no  longer  beautiful,  but  to  the 
botanist  who  sees  the  larger  truths  discovered  in  its 
structure,  the  beauty  is  only  enhanced. 

Pulling  apart,  dissection,  analysis,  results  in  ugli- 
ness to  the  untrained  eye.  To  the  layman  a  dis- 
sected human  body,  while  it  may  excite  curiosity,  or 
even  wonder,  can  never  be  beautiful;  and  so  it  is 
with  the  human  soul.  To  the  unprepared  a  human 
soul,  from  which  its  surface  has  been  removed  and 
which  thus  discloses  its  inner  structure,  is  an  ugly 
sight;  but  as  in  the  example  of  the  botanist,  the 
trained  observer  can  only  be  thrilled  with  the  won- 
derful beauty  of  the  marvellous  adaptations  which 
are  there  disclosed  to  view. 

The  history  of  the  psychoanalytic  movement  in 
the  past  few  years  is  not  unlike  the  history  of  the 


290  MENTAL  HYGIENE 

dissection  of  the  human  body.  Science  has  always 
had  to  fight  its  way  against  prejudice,  but  in  these 
two  directions,  the  dissection  of  the  body  and  the 
dissection  of  the  mind,  the  prejudice  seems  to  be  of 
similar  character.  The  tremendous  opposition  that 
had  to  be  overcome  before  human  dissection  was 
rendered  possible  seems  to  me  to  be  in  no  small  part 
dependent  upon  the  antagonism  which  man  has  of 
having  the  secrets  of  his  inner  self  laid  bare.  The 
human  body  was  considered  to  be  sacred,  to  be  in- 
violate, and  dissection  was  a  matter  of  desecration 
because  man  felt  that  the  very  citadel  of  his  person- 
ality was  being  invaded.  It  is  the  same  thing  with 
psychoanalysis,  only  perhaps  the  invasion  is  still 
more  undesirable,  for  it  is  no  longer  simply  the  body 
that  is  invaded,  but  the  very  innermost  of  his  being, 
and  to  cap  the  climax,  psychoanalysis  has  dared  to 
inquire  into  that  most  personal  of  all  elements  in 
our  make-up, — sexuality.  Naturally  we  might  ex- 
pect a  tremendous  opposition  to  this  movement. 

We  have  seen  that  as  man  has  developed  he  has 
had  progressively  to  give  up  more  and  more  of  his 
primitive,  instinctive  tendencies  as  the  price  for  a 
higher  civilization  with  all  of  its  inestimable  benefits. 
As  these  instinctive  tendencies  have  been  overcome 
they  have  been  relegated  to  the  unconscious  and  out 
of  the  successes  attained  in  the  overcoming  have 
been  forged  the  weapons  with  which  to  win  a  new 
victory.  Simply  because  these  cravings  have  been 
overcome  and  buried  in  the  unconscious  does  not 
mean  they  have  ceased  to  exist  nor  that  they  have 


PSYCHOANALYSIS  291 

ceased  to  be  able  to  influence  the  individual.  Like 
long  forgotten  events  that  a  chance  association 
brings  flashing  into  the  memory  they  may  be  stirred 
to  activity  at  any  time,  or  forgotten  and  apparently 
non-existent  they  may  nevertheless  exercise  a  con- 
tinuous but  subtle  effect  upon  the  conscious  activi- 
ties. The  poet  Grillparzer  ceased  to  be  able  to 
write  poetry  at  twenty-eight  following  the  suicide  of 
his  mother.  He  was  in  the  midst  of  his  composition 
the  "Golden  Fleece."  He  picked  up  the  thread  of 
his  lost  art  again,  however,  on  the  occasion  of  play- 
ing Mozart's  Symphony  in  G  minor  with  a  mother 
substitute,  a  woman  who  re-awakened  his  mother 
associations.  This  was  the  last  piece  he  had  played 
four-handed  with  his  mother  before  her  death,^  and 
so  served  to  give  him  access  again  to  those  sources 
of  energy  which  had  been  cut  off. 

In  the  unconscious,  then,  we  find  the  instinct  mo- 
tive for  conduct,  which  is  the  motive  of  the  familiar, 
the  usual  reaction  (habit),  the  easiest  way,  in  short 
the  pleasure  motive.  At  the  level  of  clear  conscious- 
ness reason  and  judgment  hold  sway;  here  the  mo- 
tive is  the  reality  motive,  a  clear-cut,  conscious,  in- 
telligent relating  of  the  individual  to  the  facts  of 
existence,  which  involves  among  other  things  im- 
pressing of  instinct  in  the  service  of  reality  and 
therefore  effort,  work.  Psychoanalysis  is  essen- 
tially a  study,  by  a  special  technique  of  the  uncon- 
scious for  the  purpose  of  learning  the  part  the  in- 
stinctive motives  play  in  the  life  of  the  patient.    In 

sPfister,  1.  c,  page  120. 


292  MENTAL  HYGIENE 

the  words  of  Freud  :^  **  Psychoanalysis  originated 
on  a  medical  basis  as  a  method  of  treatment  for  cer- 
tain nervous  maladies  which  are  called  functional 
and  in  which  there  is  recognized  with  constantly  in- 
creasiug  certainty  the  result  of  disturbances  of  the 
affectivity.  It  attains  its  object  of  removing  the  ex- 
pressions of  such  disturbances,  the  symptoms,  by 
presupposing  that  these  symptoms  may  not  he  the 
only  possible  and  final  outcome  of  certain  mental 
processes^'  and  with  that  in  view,  exposes  the  history 
of  the  development  of  the  symptoms  in  the  memory, 
reawakens  the  processes  lying  underneath  these 
symptoms  and  affords  them  a  more  favourable  out- 
let under  the  guidance  of  the  physician.  .  .  .  For, 
today,  we  know  that  the  pathological  symptoms  are 
often  nothing  else  than  substitute  formations  for 
bad,  i.  e.  unsuitable,  tendencies,  and  that  the  condi- 
tions of  the  symptoms  are  established  in  the  years 
of  childhood  and  adolescence — at  the  same  time  in 
which  the  individual  is  the  object  of  education — 
whether  the  maladies  actually  appear  in  youth  or 
only  in  a  later  period  of  life. 

* '  Education  and  therapy  now  appear  in  a  recipro- 
cal relation  to  each  other.  Education  will  take  care 
that  from  certain  dispositions  and  tendencies  of  the 
child,  nothing  harmful  to  the  individual  or  society 
shall  proceed.  Therapy  will  come  into  play  if  these 
same  dispositions  have  already  caused  the  unwished- 
for  result  of  a  pathological  symptom." 

6  Pfister,  1.  c,  p.  V. 

7  Italics  mine. 


PSYCHOANALYSIS  293 

Here  is  the  key  to  the  situation.  An  analysis  is 
for  the  purpose  of  reconstructing  the  psychological 
history  of  the  patient  so  far  as  that  history  bears 
upon  the  formation  of  the  symptoms.  As  soon  as 
we  do  this  we  invariably  find  that  the  symptom  rep- 
resents, symbolizes,  a  form  of  instinctive  activity 
which  belongs  to  the  period  of  infancy  and  should 
have  been  renounced  as  the  child  grew  to  adulthood 
but  which  because  of  some  special  emphasis  has  been 
retained.  To  show  the  immense  practical  import- 
ance of  this  psychoanalytic  point  of  view  I  here  re- 
peat the  list  of  disorders  cited  in  Chap.  II  and  taken 
from  the  recent  literature,  which  were  found  to  be 
mental  in  origin  although  for  the  most  part  they 
were  apparently  physical  disorders.  I  think  it  will 
be  admitted  that  many  of  most  of  these  ailments 
would  be  apt  at  least  to  be  treated  by  other  than  psy- 
chological methods.  This  list  includes  many  forms 
of  asthma,  sore  throat,  difficult  nasal  breathing, 
stammering,  headache,  neurasthenia,  backache,  ten- 
der spine,  ''weak  heart,"  fainting  attacks,  exoph- 
thalmic goitre,  aphonia,  spasmodic  sneezing,  hic- 
cough, rapid  respiration,  hay  fever,  gastro-intes- 
tinal  disturbance  (constipation,  diarrhoea,  indiges- 
tion, colitis,  gastric  ulcer),  ptosis  of  kidney,  diabetes, 
disturbances  of  urination  (polyuria,  incontinence, 
precipitancy),  menstrual  disorders,  auto-intoxica- 
tion (from  long  continued  digestive  disturbances), 
nutritional  disorders  of  skin,  teeth,  hair,  etc.,  etc. 
The  list  might  be  indefinitely  prolonged.  I  will 
briefly  add  examples  of  apparently  physical  disorder 


294  MENTAL  HYGIENE 

for  purposes  of  illustration,  which  proved  on  analy- 
sis, however,  to  be  psychological  in  origin. 

Of  the  vasomotor  disorders  I  cite  the  case  of  ^  a 
fifteen  year  old  girl  who  during  analysis  exhibited 
swollen  lips.  This  had  occurred  once  five  years  be- 
fore when  a  student  had  tried  to  kiss  her  but  she  had 
successfully  resisted  him.  A  similar  attempt  had 
been  made  before  the  later  recrudescence  of  the 
symptoms. 

As  an  example  of  a  skin  eruption  is  the  case  of  a 
young  woman  ^  who  had  areas  of  erythema  on  both 
forearms.  These  areas  did  not  tan  on  exposure  to 
the  sun  as  did  the  rest  of  the  skin.  Analysis  showed 
that  the  erythematous  areas  were  the  places  which 
had  been  grasped  by  the  mother-in-law  in  a  very 
emotional  scene  between  them.  The  erythema  dis- 
appeared following  the  analysis  and  the  skin  in  that 
area  then  tanned  on  exposure. 

Certain  cases  show  well  that  disturbances  of  men- 
struation, dysmenorrhoea  and  suppression  may  be 
purely  psychogenic,  due  often  to  a  timid,  prudish, 
neurotic  mother  who  scares  her  daughter  over 
the  onset  of  the  new  function,  or  leaves  her  in 
ignorance  to  conjure  up  her  own  fears  on  its  appear- 
ance. Subsequent  local  treatments,  curettage,  ven- 
tral suspension,  etc.,  not  only  may  not  help  but  may 
aggravate  the  anxiety,  make  the  patient  decidedly 
worse  because  of  course  they  do  not  go  to  the  root  of 
the  trouble  but  only  deal  with  results. 

sPfister,  1.  c,  p.  32. 

9  Case  communicated  by  Dr.  E.  J.  Kempf. 


PSYCHOANALYSIS  295 

I  have  cited  these  examples  for  the  purpose  of 
showing  that  psychogenic  disorders  are  by  no  means 
confined  to  such  types  as  the  familiar  hysterical 
aphonias  and  hysterical  palsies,  with  which  most 
physicians  are  perfectly  familiar  and  which  are  so 
easy  to  recognize.  On  the  contrary  they  frequently 
produce  disorders  much  more  subtle  in  their  mani- 
festations, and  what  is  more,  may  involve  not  only 
deep  seated  character  defects  but  metabolic  dis- 
turbances in  which  we  are  not  accustomed  to  look 
for  signs  of  psychic  causation. 

Even,  however,  in  instances  of  such  evident  hys- 
terical reactions  the  mere  dealing  with  the  symp- 
tom and  causing  it  to  disappear  is  a  very  inadequate 
treatment,  for  it  does  not  touch  the  underlying 
trouble,  it  leaves  the  character  defect  as  it  was, 
only,  as  a  rule,  to  manufacture  new  symptoms.  For 
example,  to  revert  to  the  case  of  the  boy  of  seven- 
teen who  had  for  some  days  a  strange  feeling  in 
his  left  arm.  This  feeling  was  contemporane- 
ous with  the  desire  of  his  father  to  take  him  from 
his  present  school  and  send  him  to  another.  The 
boy  does  not  want  to  go.  Analysis  reveals  the  fact 
that  when  as  a  child  he  was  about  to  be  vaccinated 
he  struggled  so  violently  that  he  succeeded  in  avoid- 
ing the  disagreeable  experieuce.  This  experience 
was  entirely  unknown  to  the  patient  until  brought 
out  by  analysis. ^°  The  interpretation  becomes 
easy  if  we  will  use  the  formula  for  such  cases. 
The  symptoms  mean  a  wish  that  things  might  be 

loPfister,  1.  c,  p.   44. 


296  MENTAL  HYGIENE 

"as  they  were  then"  upon  that  other  occasion  when 
they  tried  to  vaccinate  him.  That  is,  he  wishes 
that  he  may  succeed,  by  his  obstinacy,  in  thwart- 
ing the  desires  of  his  father  as  he  succeeded  be- 
fore. The  treatment  of  such  a  condition  by  caus- 
ing the  disagreeable  sensation  in  the  arm  to  disap- 
pear by  suggestion  on  the  theory  that  that  is  the 
disease  can  at  once  be  seen  to  be  entirely  inadequate 
to  the  situation.  It  leaves  untouched  the  charac- 
ter defect  which  is  to  react  by  obstinacy  to  disagree- 
able situations.  In  this  respect  the  boy  is  retaining 
an  infantile  way  of  dealing  with  things  he  does  not 
like  and  needs  to  be  helped  to  grow  up,  to  develop  on 
this  side  of  his  character.  Unless  the  treatment  is 
directed  to  such  ends  it  misses  its  goal. 

The  difficulty  has  been,  in  the  past,  that  psy- 
chology has  never  employed  itself  with  such  ques- 
tions. Intrenched  in  its  laboratories  it  has  car- 
ried on  its  work  far  removed  from  the  every-day 
life  of  "the  man  in  the  street."  But  now  that  is 
exactly  what  psychoanalysis  is  demanding  of  it. 
Why  John  Smith  does  not  get  along  with  his  wife 
has  always  been  a  matter  of  absorbing  interest  to 
the  neighbourhood,  but  psychology  has  never  dig- 
nified such  a  problem  with  its  attention.  We  are 
finally  coming  to  see,  however,  that  it  is  because  we 
do  not  get  along  with  our  wives,  because  we  are  not 
interested  in  our  work,  because  we  are  not  appre- 
ciated by  our  chief,  or  are  imposed  upon  by  our 
associates,  because  we  get  too  tired,  sleep  too  little, 
drink  too  much,  because  our  salary  is  too  small,  or 


PSYCHOANALYSIS  297 

we  cannot  save,  or  the  other  fellow  who  does  not  do  as 
good  work  as  we  do  gets  more,  or  a  thousand  other 
reasons,  none  of  which  for  a  moment  cause  the  suf- 
ferer to  seek  the  advice  of  a  physician,  we  are 
finally  coming  to  see  that  it  is  just  such  things  as 
these  that  make  the  difference  between  a  happy  life, 
filled  with  usefulness,  and  failure.  Of  such  prob- 
lems from  the  point  of  view  of  the  educator  Pfister 
says:^^  *'0f  the  analytic  educational  work  with 
pupils,  who,  without  being  really  ill,  still  because 
of  inner  inhibitions,  make  themselves  and  their  fam- 
ilies unhappy,  there  is  almost  no  mention  anywhere. 
How  the  hitherto  unobserved  impressions  of  child- 
hood control  the  whole  later  development  of  the 
normal  individual,  even  to  the  peculiarity  of  his 
style,  his  choice  of  a  vocation  and  of  a  wife,  as  well 
as  the  most  insignificant  subordinate  affairs,  finds 
too  little  discussion.  The  enormous  loss  of  love  for 
fellowmen  and  of  power  for  work  which  many  in- 
dividuals suffer,  mostly  without  knowing  it,  as  a 
result  of  unfavourable  educational  influences,  have 
not,  up  to  the  present  time,  been  given  their  proper 
weight  in  the  literature.  .  .  .  Countless  numbers  of 
persons  who  bring  heart-breaking  grief  to  their 
parents  and  other  people  and  cannot  help  bringing 
it  because  they  are  under  neurotic  obsessions,  can 
by  the  aid  of  analysis  be  changed  into  agreeable, 
useful  individuals."  Unless  psychology  is  willing 
to  busy  itself  with  such  problems  it  may  well  be 
called  upon  to  justify  its  existence. 

11  Pfister,  1.  c,  p.  14, 


298  MENTAL  HYGIENE 

Psychoanalysis  is  essentially  an  educational  pro- 
cedure. Its  object  is  to  clear  away  the  rubbish 
which  is  obstructing  the  pathway  of  the  patient  so 
that  he  may  have  a  chance  to  go  forward.  This  is 
precisely  what  education  tries  to  do.  Most  em- 
phatically neither  should  try  to  impose  ideals  upon 
others  but  only  make  the  way  free  to  permit  the 
fullest  development  of  the  personality. 

The  psychoanalysts  believe  there  are  shorter  cuts 
to  the  neuroses  than  by  way  of  heredity.  Here  are 
a  couple  of  remarks  by  parents  which  recently  came 
to  my  attention.  One  mother  says  that  a  child 
has  no  morals  until  after  nine  years  of  age.  Be- 
fore that  they  are  just  little  animals  and  so  of 
course  there  is  nothing  to  do  about  it.  A  fine 
formula  to  relieve  the  parent  from  all  responsibil- 
ity and  sanction  a  program  of  do-nothingness.  An- 
other parent  believes  in  teaching  children  absolute 
obedience,  that  is,  in  completely  subjecting  them  to 
her  will  irrespective  of  their  natural  tendencies.  A 
fine  thing  for  the  parent  surely,  but  what  of  the 
child !  How  can  one  expect  a  child  in  either  one  of 
these  households  to  develop,  how  is  it  going  to  be 
possible  to  get  any  chance  at  all,  and  as  a  result 
must  it  not  almost  surely  h^,ppen,  that,  thwarted 
in  its  natural  avenues  of  expression  it  will  seek  the 
by-ways — and  that  is  the  stuff  out  of  which  the 
neurosis  and  future  inefficiency  and  unhappiness 
is  built. 

From  the  cases  thus  far  it  will  be  evident  that  the 
theory  that  accounts  for  the  later  neurosis  assumes 


PSYCHOANALYSIS  299 

that  tlie  trouble  began  in  the  early  years  of  child- 
hood, not  as  the  result  of  some  concrete  sexual 
trauma,  as  many  people  still  think,  but  as  the  nat- 
ural consequence  of  a  fixation  of  certain  areas  of 
the  child's  interest,  so  that  in  this  particular  re- 
spect he  does  not  grow  up.  The  cause  of  this  fixa- 
tion, or  for  our  present  purposes  we  may  call  it  de- 
tention of  the  libido  or  interest  on  the  road  of  de- 
velopment, is  that  the  child 's  interest  is  too  strongly 
attracted  because  of  the  undue  pleasure  premium 
which  this  particular  area  of  interest  offers.  In 
the  case  of  the  asocial  ways  of  using  the  ear  libido 
already  mentioned,  for  instance,  it  would  probably 
be  found  that  the  child  was  very  early  attracted  to 
listening  ways  of  pleasure  seeking  because  of  hav- 
ing heard  or  having  been  told  about  forbidden  sex- 
ual matters  that  he  found  absorbingly  interesting. 
Only  by  finding  such  things  in  the  history  can  the 
later  development  be  understood.  That  the  matter 
was  sexual  is  only  ventured  because  that  is  what 
would  be  expected  from  experience.  That  all  pleas- 
ure founds  in  the  last  analysis  in  sex  pleasure  is  an 
hypothesis  forced  upon  the  analyst  by  his  daily  ex- 
perience, it  is  not  an  arbitrary  hypothesis  into  which 
he  tries  to  make  every  fact  fit.  This  hypothesis 
that  all  pleasure,  in  its  ultimate  analysis,  is  re- 
ducible to  that  quality  of  emotion  which  is  asso- 
ciated with  the  most  important  act  in  the  life  of 
the  individual,  from  the  point  of  view  of  the  wel- 
fare of  the  race,  is  not  a  whit  more  surprising  or 
more  radical  than  the  generalization  that  all  of  the 


300  MENTAL  HYGIENE 

attributes  of  life  are  traceable  to  the  single  prop- 
erty of  protoplasm — irritability.  After  all  it  is  of 
less  practical  importance  to  answer  the  question 
''whence"  than  to  answer  the  question  "whither." 
It  is  only  a  matter  of  detail  how  we  reply  to  the 
query  "whence"  for  in  any  case  we  have  all 
travelled  the  same  evolutional  pathway.  It  is, 
however,  of  the  vastest  importance  to  the  individual 
that  he  should  be  able  to  make  the  best  use  of  his 
opportunities,  that  he  should  be  able  to  answer  the 
question  "whither"  in  a  satisfactory  way. 


CHAPTER  X 
SUMMAEY 

In  this  final  summary  it  will  be  my  object  to  gather 
up  all  the  various  threads  which  I  have  followed  in 
the  preceding  chapters  and  attempt  to  show  how 
they  are  related  in  the  vast  and  intricate  pattern 
of  human  activities.  I  can  not  of  course  hope  to 
do  this  in  any  at  all  adequate  way  for  the  beauty 
and  the  complexity  of  the  pattern  must  always  far 
exceed  the  capacity  to  describe  it.  I  will  neverthe- 
less attempt  to  present  those  salient  elements  in  the 
pattern  which  are  of  immediate  and  prime  impor- 
tance for  the  problem  in  hand. 

From  the  material  Osborn  has  given  us  in  his 
*'Men  of  the  Old  Stone  Age"  we  may  picture  primi- 
tive man  in  form,  appearance,  and  intelligence 
closely  resembling  present  day  Simians.  A  crouch- 
ing, hall  stooped  animal  of  great  strength,  with  re- 
ceding forehead  and  ferocious  face,  with  enough  in- 
telligence to  pick  up  and  use  a  stone  as  a  weapon 
or  perhaps  to  rudely  form  it  by  chipping  it  with  an- 
other, but  probably  not  enough  to  fashion  clothes  to 
protect  him  from  the  cold.  Such  men  probably 
early  grouped  themselves  together  in  small  bands, 
probably  driven  to  do  so  to  protect  themselves  the 
better   against   the   wild,   ferocious    animals   with 

301 


302  MENTAL  HYGIENE 

whicli  they  had  to  contend,  although  some  social  psy- 
chologists would  hold  that  it  was  because  they  were 
possessed  of  a  gregarious  instinct.  We  can  imagine 
such  a  group  in  one  of  the  caves  they  frequented, 
both  for  safety  and  for  protection  from  the  cold, 
gathered  about  the  carcass  of  an  animal  which  they 
had  hunted  to  the  death.  In  such  a  group,  could 
we  revive  it,  we  would  probably  observe  noisy  quar- 
relling over  specially  desired  parts  of  the  animal, 
and  after  their  hunger  was  appeased  probably  a 
similar  type  of  behaviour  on  the  part  of  the  males 
for  the  possession  of  the  females,  in  the  end  domi- 
nated by  the  largest  and  most  powerful,  much  as 
we  can  see  the  same  reactions  today  in  any  cage  of 
monkeys.  In  such  a  group  the  primitive  instincts 
hold  sway  and  it  is  out  of  such  material  that  a 
future  highly  complex  society  with  all  its  infinitely 
complex  relationships  must  be  developed. 

If  we  will  examine  this  primitive  community  with 
a  little  more  care  we  will  see  that  it  owes  its  exist- 
ence to  factors  with  which  we  are  perfectly  familiar. 
If,  for  example,  the  strongest  man  were  to  take  all 
the  food  the  others  would  starve,  and  so  such  con- 
duct, which  we  recognize  as  selfish,  would  tend  to 
the  destruction  of  the  herd  and  therefore  of  the  ad- 
vantages which  such  grouping  offered.  Similarly, 
if  in  their  quarrels  the  strong  killed  the  others  the 
same  result  would  tend  to  issue,  namely,  the  destruc- 
tion of  the  herd.  From  the  very  first,  therefore,  it 
is  evident  that  in  order  that  the  social  group  may 
continue  in  existence  and  function  the  individual 


SUMMARY  303 

members  must  give  up  something  which  they  might 
retain,  must  learn  to  exercise  restraint  over  their  de- 
sires, which  they  might  give  free  rein.  At  the  very 
moment  of  its  coming  into  existence  then  the  herd 
makes  certain  demands  of  the  individual  so  that  at 
once  the  interests  of  the  individual  and  the  herd 
tend  to  define  themselves  as  separate  issues  and  to 
array  themselves  as  opposing  forces  in  the  mind  of 
the  individual — the  conflict  (Chap.  IV) — out  of  the 
clash  of  which  will  be  forged  the  enduring  struc- 
tures of  civilized  society. 

Already  at  this  earliest  stage  in  the  development 
of  human  society  man,  the  animal,  has  developed 
to  the  capacity  for  reacting  at  a  psychological  level 
(Chap.  II),  that  is,  his  evolution  has  proceeded  to 
such  a  point  that  psychological  reactions  are  possi- 
ble. In  fact,  the  psychological  reactions  which  I 
have  described  are  plainly  kin  to  those  which  we 
recognize  in  our  own  experience — they  are,  however, 
mainly  what  we  would  term  affective  (that  is  emo- 
tional) rather  than  intellectual;  they  are  expressed 
in  feelings  rather  than  in  ideas. 

Development  from  this  point  on  depends  upon 
two  fundamental  elements;  the  development  of  the 
individual  as  such  and  the  development  of  society. 
To  the  interplay  of  these  two  factors  are  traceable 
all  the  manifold  complexities  of  character  and  of 
the  herd.  A  few  comments  upon  the  characteris- 
tics of  these  two  basal  elements  is  therefore  in 
order. 

It  has  already  been  indicated  that  the  interests 


304  MENTAL  HYGIENE 

of  the  individual  and  of  the  herd  may  be  opposed. 
If,  for  example,  the  strongest  man  in  a  small  group 
took  all  the  food  for  himself  the  others  would  per- 
ish. The  emphasis  in  this  illustration,  however, 
needs  to  be  put  upon  the  fact  that  while  he  who 
by  his  selfishness  had  thus  appropriated  all  of  the 
means  of  subsistence  might  superficially  be  sup- 
posed to  have  profited  by  so  doing,  still  any  profit 
which  accrued  from  such  conduct  could  only  be 
temporary.  Furthermore,  the  matter  does  not 
stop  there.  Not  only  is  the  profit  but  temporary  but 
following  this  temporary  period  of  profit  the  re- 
sults are  destructive.  Not  only  has  the  herd  been 
destroyed,  not  only  has  the  survivor  lost  all  the 
benefits  which  association  together  for  a  common 
purpose  gave  him,  but,  and  here  is  the  matter  of 
prime  significance,  the  survivor  has  lost  that  milieu 
in  which,  and  in  which  alone,  he  could  develop  his 
own  individuality.  The  whole  development  of  both 
the  individual  and  of  society  can  thus  be  traced  in 
the  constant  clash  and  interplay  of  these  two  ele- 
ments. 

In  general  it  may  be  said  that  as  both  the  in- 
dividual and  society  develop  that  they  do  so  only 
because  man  has  been  able  more  and  more  to  give 
up  the  immediate  satisfaction  of  his  desires,  to 
put  oif  their  fulfilment  until  a  more  opportune  time. 
He  has  been  able  to  sacrifice  his  immediate  wishes 
and  put  off  their  fulfilment  into  an  ever  receding 
future  and  occupy  his  energies  meantime  in  some- 
thing else — sublimation.    Taking  the  example  al- 


SUMMARY  305 

ready  used,  he  comes  to  appreciate  the  distinctions 
of  meum  and  tuum,  and  instead  of  taking  what  he 
wants  from  his  fellow  he  respects  his  ownership 
and  sets  about  in  constructive  ways  to  earn  the 
power  to  purchase  it  from  him. 

In  this  progress  from  the  simplest  group  to  the 
more  complex  with  the  contemporaneous  conflict 
between  the  individual  interests  and  the  interests 
of  the  herd  man  feels  first  and  acts  upon  impulse  and 
as  a  result  of  emotion  long  before  he  learns  to 
think  with  the  use  of  clear  cut  ideas  and  carefully 
checked  up  judgments.  Feelings  are  the  more 
homogeneous  and  crude  responses  at  the  psycho- 
logical level  which  precede  in  development  those 
responses  to  which  we  give  the  name  intellectual.^ 

The  emotional  type  of  response  is  not  only  more 
general  and  homogeneous,  that  is,  lacking  in 
specificity,  but  it  is  characterized  by  an  absence  of 
projection  and  a  relation  of  the  stimulus  to  the 
body  rather  than  to  an  external  object,  and  it  is 
also  a  whole  or  nothing  type  of  reaction.^  It  is 
only  slowly,  through  countless  ages   of  trial  and 

1  For  certain  evidences  that  this  phylogenetic  succession  is  repre- 
sented in  like  manner  in  the  structure  and  the  functions  of  the  hu- 
man brain  see  the  author's  "Mechanisms  of  Character  Formation." 

2  By  the  whole  or  nothing  response  is  meant  that  there  is  an 
absence  of  the  appreciation  of  degree.  For  example,  in  certain 
pathological  conditions,  the  application  of  extremes  of  heat  or  cold 
are  intensely  disagreeable.  The  disagreeable  feeling,  however,  does 
not  begin  with  minor  degrees  of  the  stimulus  but  when  it  has  reached 
a  certain  degree  of  intensity  the  feeling  of  disagreeableness  in  its 
fullest  intensity  leaps  suddenly  into  consciousness.  Either  there  is 
no  such  feeling  or  else  the  feeling  is  present  in  full  force. 


306  MENTAL  HYGIENE 

error  and  by  way  of  the  path  of  tremendous  suffer- 
ing that  the  originally  extensive,  affective,  rela- 
tively undifferentiated  whole  or  nothing  type  of  re- 
sponse related  primarily  to  the  body  is  replaced  in 
part  by  the  relatively  intensive,  differentiated,  pro- 
jected variety. 

If  we  will  bear  these  characteristics  of  emotional 
response  in  mind  in  comparing  the  reactions  of 
primitive  man  with  present  day  intellectual  types 
of  reaction  we  will  get  a  useful  viewpoint  on  man's 
behaviour  in  its  genetic  setting.  For  example,  we 
will  understand  anew  the  type  of  reactions  described 
in  a  previous  chapter  (Chap.  V)  in  the  discussion 
of  the  criminal  as  scapegoat.^  These  reactions  are 
reactions  against  evil  and  sin  in  general  by  attempt- 
ing to  transfer  them  to  something  or  somebody 
and  then  by  destroying  that  something  or  somebody 
getting  rid  of  them.  The  extremely  general  type 
of  these  reactions  is  seen  in  the  fact  of  the  choice 
of  scapegoats.  Animals  or  men  are  not  chosen  be- 
cause of  any  relation  which  they  may  bear  to  the 
evil  it  is  desired  to  be  rid  of  but  for  entirely  different 
reasons — usually  because  they  are  captives  or  con- 
demned criminals.  Then  again  it  is  seen  in  the 
periodical  ceremonials  for  the  expulsion  of  evils 
which  are  indulged  in  whether  there  is  special  need 
for  them  or  not.  Later  in  the  development,  as  I 
pointed  out,  there  is  a  tendency  to  choose  as  a  human 
scapegoat  a  condemned  criminal.  But  this  is  a  re- 
action against  human  sacrifice  and  hardly  a  nearer 

3  See  Frazer :  "The  Scapegoat." 


SUMMARY  307 

approach  between  the  scapegoat  and  the  producer  of 
the  evil.  In  fact  there  is  evidence  that  it  was  once 
the  custom  to  hang  the  thief  first  and  investigate 
afterwards.*  In  other  words,  the  evil  had  first  to 
be  gotten  rid  of,  the  crime  expiated,  then  matters  of 
detail  might  be  gone  into.  The  important  thing  was 
done  first.  This,  of  course,  is  a  typical  emotional 
response  in  its  indefiniteness,  its  lack  of  specificity. 
And  too,  it  lacks  characteristically  the  quality  of 
projection.  The  whole  process  goes  on  in  the  in- 
dividual. The  feeling  of  the  necessity  for  an  emo- 
tional emptying  is  aroused  by  a  crime;  the  hang- 
ing produces  relief  from  the  emotional  tension; 
incidentally  some  one  is  hanged;  the  relation  of 
the  one  hanged  to  the  crime  is  a  matter  to  be  worked 
out  by  the  slow  painstaking  development  we  call 
civilization.^ 

The  characteristics  of  emotional  response  as  dif- 
ferentiating it  from  the  intellectual  type  will  bear 
some  further  elaboration.  We  have  seen  that  it  is 
more  general — lacking  in  specificity.  This  change 
from  the  indefinite  to  the  definite  of  course  char- 
acterizes all  progress.  Typhoid  fever  was  first  just 
an  evil,  then  an  illness,  then  a  special  kind  of  ill- 
ness, and  finally  a  specific  illness  due  to  the  typhoid 
bacillus. 

4  Grimm,  J. :  "Deutsche  Rechtsaltertiimer,"  cited  by  Jelliffe,  S.  E., 
"Technique  of  Psychoanalysis,"  The  Psychoanalytic  Revieio,  April, 
1917. 

5  Some  idea  of  the  extreme  slowness  and  laboriousness  of  this 
development  can  be  had  by  studying  the  development  of  flint  tools 
as  told  by  Osborn  in  his  "Men  of  the  Old  Stone  Age." 


308  MENTAL  HYGIENE 

Perhaps  the  most  important  characteristic  of  the 
emotional  response,  however,  is  the  lack  of  projec- 
tion.® We  have  seen  (Chap.  Ill)  that  from  the  very 
first  the  tendency  is  for  the  baby  to  be  self-sufficient, 
to  keep  within  himself,  that  reality  has  to  come 
repeatedly  knocking  at  the  door  and  really  to  cause 
pain  and  suffering  before  it  receives  adequate  rec- 
ognition. It  is  only  as  a  result  of  such  repeated  de- 
mands that  man  finally  learns  to  project  his  in- 
terests outside  of  his  own  body  and  to  take  inter- 
est in  reality.  Even  after  he  does  this,  however,  the 
projection  mechanism  is  susceptible  of  serious  dis- 
tortions, which  nevertheless  serve  a  purpose  in  evo- 
lution and  only  become  pathological  when  they  re- 
tard progress.  As  we  have  seen,  (Chap.  Ill)  when 
this  projected  interest  meets  with  an  obstacle  it  is 
felt  as  though  it  came  back  from  the  outside  world 
in  the  form  of  a  destructive  influence — hate,  if  it 
comes  from  an  individual,  quite  often  some  mys- 
terious and  maleficent  force,  if  from  an  inanimate 
object. 

The  projection  mechanism  is  the  mechanism  with 
which  man  comes  in  contact  with,  feels  out,  reality. 
It  is  also  the  mechanism  through  which  he  comes 
to  the  first  efforts  at  repression  of  his  own  instinc- 
tive tendencies  through  the  development  of  the 
antipathic  emotions.  That  is,  he  projects  his  own 
instinctive  tendencies  upon  the  persons  of  others 

6  Projection  is  here  used  in  the  sense  of  objectivation,  which  is 
possibly  the  better  term  as  projection  has  a  technical  significance  in 
psychiatry    (see  Chap.  III.) 


SUMMARY  309 

and  then  proceeds  to  kill  or  otherwise  do  away  with 
those  others.  It  is  the  principle  of  the  scapegoat, 
but  man  never  suspects  that  this  is  the  meaning  of 
so  many  of  his  hates  and  antipathies.  The  member 
of  the  tribe  who  offends  a  tribal  law  or  custom  is 
forthwith  killed  and  by  so  doing  the  tribe  is  saved 
from  his  further  disintegrating  influence,  but  in  ad- 
dition, for  those  who  took  part  in  the  killing,  actually 
or  by  lending  their  sympathy,  a  similar  delinquency 
is  rendered  much  more  impossible,  the  prohibition 
is  greatly  increased — reinforced. 

That  we  are  still  a  long  way  from  having  evolved 
an  intellectual  type  of  society  I  think  all  will  ad- 
mit. We  are  still  almost  entirely  controlled  by  our 
feelings  and  such  reactions  as  I  have  just  outlined 
are  largely  in  evidence  in  our  everyday  life.  The 
petty  jealousies  and  antagonisms  of  any  group  of 
people  who  are  closely  associated  are  instances  in 
point.  In  fact  perhaps  it  is  not  desirable  that  we 
should  be  entirely  controlled  by  our  intelligences, 
but  it  certainly  is  desirable  that  our  feelings  should 
develop  beyond  the  infantile  type  which  makes  such 
reactions  possible. 

Finally,  however,  man  does  come  to  have  some 
measure  of  control  over  his  instinctive  tendencies 
as  a  result  of  the  development  of  what  we  call  his 
intelligence.  The  energy  transformations  which 
occur  at  the  level  of  intelligence  are  mediated  by 
ideas  which  act  as  symbols  for  energy  at  this  level.'^ 

7  For  the  symbol  as  carrier  of  energy  see  the  author's  "Mechanisms 
of  Character  Formation." 


310  MENTAL  HYGIENE 

The  idea  becomes  then  a  much  finer  tool  than  the 
feeling  for  cutting  into  reality  and  so  develops  ac- 
cordingly.^ 

It  is  perhaps  because  the  idea  is  a  so  much  more 
efficient  tool  than  the  feeling  that  it  has  developed 
so  much  more  rapidly.  We  have  a  rich  language 
of  ideas  but  our  capacity  to  describe  our  feelings 
by  words  is  very  limited  by  comparison. 

With  the  material  of  his  instincts,  his  feelings,  his 
ideas  and  finally  his  ideals  we  see  man  struggling 
with  the  great  problem  of  his  nature,  the  conflict 
between  his  self-preservation  (nutritional)  and  his 
race-preservation  (sexual)  tendencies  projected  into 
the  larger  issues  of  individuality  versus  society. 
On  this  great  battle  field  the  victory  goes  in  the 
main  to  those  best  fitted  to  survive.  The  great  gen- 
eral average  of  results  is  in  the  line  of  progress  but 
in  reaching  this  average  much  that  is  worth  while 
must  necessarily  go  down  to  destruction.  All  along 
the  line  of  progress  those  who  wander  too  far  from 
the  path  of  success  fail  completely  while  in  between 
is  every  degree  of  failure  or  of  success  depending 
upon  the  angle  from  which  one  chooses  to  consider 
it. 

It  is  necessary  to  view  the  questions  of  social  in- 
adequacy, as  I  have  called  them,  from  this  broader 
horizon  in  order  to  adequately  appreciate  the  mean- 

8  This  statement  is  rather  loosely  phrased.  Instead  of  an  idea 
being  a  tool  to  cut  into  reality  in  this  sense,  that  is,  that  it  is  made 
de  novo  for  that  purpose,  it  represents  a  reaction  at  the  psycho- 
logical level  which  is  successful  in  proportion  to  the  success  of  what 
went  before  and  out  of  which  the  idea  was  born. 


SUMMARY  311 

ings  of  the  several  problems — individual  or  group. 
When  we  do  this  we  can  see  that  practically  all  of 
the  varieties  of  failure,  such  as  I  have  discussed  in 
the  preceding  pages,  are  dependent  upon  develoi^- 
mental  failure.  The  individual  or  the  group,  as  the 
case  may  be,  has  not  been  able  to  ''keep  up  with 
the  procession." 

Next  to  realizing  social  inadequacy  as  a  develop- 
mental defect  is  the  localization  of  this  defect  in  the 
cultural  history  of  both  the  race  and  the  abbrevia- 
tion of  this  historical  record  as  we  see  it  in  the  de- 
velopment of  the  individual.  For  example:  nail 
biting  would  be  recognized  as  a  bad  habit  brought 
over  from  the  period  of  infancy;  many  fears  can 
be  traced  to  actual  experiences  in  early  life ;  prosti- 
tution, on  the  other  hand,  would  seem  to  hark  back 
in  its  origin  to  an  earlier  racial  promiscuity;  while 
lying  and  stealing,  involving  as  they  do  a  certain 
type  of  defect  in  what  might  be  called  social  con- 
sciousness, can  be  appreciated  as  partaking  both  of 
individual  and  racial  qualities.  Of  course,  in  the 
last  analysis,  probably  all  defects  of  any  moment 
derive  from  both  sources. 

To  express  all  the  symptoms  of  social-inadequacy 
in  terms  which  would  denote  the  stage  of  develop- 
ment reached  as  indicated  in  the  sjanptom  is  not 
at  present  possible  because  the  stages  of  cultural 
development  as  represented  in  racial  progress  have 
not  yet  been  translated  into  psychological  terms. 
Theoretically  this  should  be  possible.  I  have  al- 
ready   indicated     (Chap.    IX)     one    such    stage, 


312  MENTAL  HYGIENE 

namely,  animism.  There  probably  could  be  out- 
lined a  number  more.  Jelliffe^  would  define  one 
such  stage  as  that  in  which  animals  appear  in  the 
unconscious  symbolisms  with  great  frequency  as 
typified  in  Ovid's  Metamorphoses.  Another  stage 
might  easily  be  a  sadistic  (cruelty)  stage  as  sym- 
bolized by  the  Inquisition.  Others  could  easily  be 
suggested  and  for  each  stage,  to  carry  out  the  geo- 
logical figure  already  employed,  there  would  be  spe- 
cial variants  just  as  special  fossils  are  found  in  par- 
ticular geological  strata.  This  way  of  looking  at 
the  phenomena  gives  one  at  once  a  breadth  of  hori- 
zon and  at  the  same  time  furnishes  a  scheme  into 
which  can  be  fitted  particular  and  unusual  instances 
in  a  helpful  way,  a  way  that  gives  them  meanings. 

In  addition  to  this  way  of  classifying  the  material 
it  is  necessary  also  to  attempt  to  evaluate  the  seri- 
ousness of  the  reaction  in  a  particular  instance  and 
note  whether  it  is  for  the  most  part  dependent  upon 
defects  resident  within  the  individual  or  causes  ex- 
ternal to  him.  Both  etiologies  may  produce  a  con- 
dition which  outwardly  appear  the  same.  In  the 
one  case  the  person  reacts  with  symptoms  which 
show  his  level  of  development,  in  the  other  case 
outward  circumstances  which  he  cannot  adjust  to 
drive  him  back  within  himself  to  the  same  level. 
One  person  may  develop  a  stupor  as  result  of  a 

9  Jelliffe,  S.  E.,  and  Brink,  L. :  "The  Role  of  Animals  in  the  Un- 
conscious, with  some  remarks  on  Theriomorphic  Symbolism  as  seen 
in  Ovid,"  The  Psychoanalytic  Review,  July,  1917. 


SUMMARY  313 

gum  boil,  another  only  when  faced  with  the  hopeless- 
ness of  a  long  term  in  prison. 

Then  again  as  to  the  seriousness  of  the  reaction. 
This  may  be  shown  by  the  necessity  for  escaping 
from  reality.  A  man  who  occasionally  drinks  too 
much  when  out  with  a  crowd  of  men  having  a  good 
time  is  not,  other  things  being  equal,  nearly  so 
seriously  involved  as  one  who  from  time  to  time 
buys  a  supply  of  whiskey  and  then  goes  to  his 
room,  pulls  all  the  shades  down  so  as  to  darken  it 
thoroughly,  goes  to  bed,  and,  alone,  proceeds  to 
drink  himself  into  unconsciousness. 

Having  outlined  the  nature  of  the  problem  of  so- 
cial-inadequacy in  its  multitudinous  ramifications 
and  reached  some  understanding  of  what  it  means 
both  in  the  large  and  in  its  particular  manifesta- 
tions, there  remain  a  few  things  that  I  wish  to  say 
about  the  way  these  problems  should  be  approached 
in  order  to  insure  the  best  results. 

I  have  intimated  all  through  the  book  that  if  we 
are  to  really  accomplish  lasting  results  for  better- 
ment the  approach  should  be  with  love,  using  that 
word  not  to  mean  anything  approaching  sentimental- 
ism,  but  in  its  broader  sense  as  opposed  to  hate. 

As  already  indicated  the  mechanism  of  projec- 
tion, or  perhaps  better  objectivation,  transferring 
our  interests  to  and  seeing  them  in  the  outside 
world,  is  the  mechanism  by  which  we  come  into  con- 
tact with  reality.  Love  is  the  indication  of  success 
while  hate  is  the  reaction  which  indicates  a  car- 


314  MENTAL  HYGIENE 

tain  measure  of  failure.  Love  is  positive  and  goes 
ahead,  hate  is  occupied  with  trying  to  avoid  certain 
obstacles  only,  by  objectifying  them  and  then  de- 
stroying them.  Love  is  the  path  of  interest  which 
takes  us  out  of  ourselves,  hate  is  the  path  that  turns 
us  back  within.    Love  is  creative,  hate  destructive. 

We  have  seen  how  the  constructive  attitude  as  ap- 
plied to  the  insane  has  infinitely  ameliorated  their 
condition  in  recent  years  and  led  to  studies  which 
are  throwing  ever  more  light  upon  the  meanings  of 
so-called  insane  reactions.  We  have  seen  also  how 
the  attitude  of  hate  has  equally  retarded  any  such 
similar  progress  in  humanitarian  endeavour  or 
scientific  enlightenment  in  the  case  of  the  so-called 
criminal  classes.  It  behooves  us,  therefore,  to  take 
stock  of  ourselves,  to  look  within  and  see  whether 
our  own  attitude  does  not  need  orienting  towards  the 
problem  if  we  are  to  get  the  best  results. 

If  we  will  do  this  it  will  be  apparent  that  our 
attitude  has  to  be  planned  on  a  higher  plane  of  con- 
duct than  that  I  have  referred  to  as  typical  of  the 
attitude  towards  the  criminal.  In  other  words,  noth- 
ing will  be  accomplished  so  long  as  the  attitude  is 
one  of  hate,  or  to  use  less  harsh  terms,  the  products 
of  attempts  to  rationalize  our  hate,  retribution  or 
punishment.  So  long  as  this  is  our  attitude  towards 
any  problem  nothing  can  be  accomplished  because 
we  are  not  objectifying  our  best  but  our  worst,  we 
are  really  only  treating  ourselves  to  a  certain 
amount  of  self-indulgence — small  on  the  average 
but  a  veritable  orgy  when  a  lynching  is  the  form  of 


SUMMARY .  315 

expression.  Such  a  reaction  partakes  of  all  of  the 
limiting  characteristics  of  the  emotional  as  against 
the  intellectual  which  I  have  already  pointed  out. 

Freed  from  the  limitations  and  distortions  of  an 
emotional  attitude  the  attack  on  the  problem  of  so- 
cial inadequacy  needs  to  keep  primarily  in  mind  the 
development  of  a  program  which  will  help  to  bring 
about  better  conditions.  Such  a  program  has  two 
elements  to  consider;  the  welfare  of  the  individual 
and  the  welfare  of  society.  Further  it  may  be  ac- 
cepted that  no  really  constructive  program  can  is- 
sue as  a  result  of  purely  repressive  measures. 

I  have  already  emphasized  the  necessity  of  con- 
sidering both  the  individual  and  society.  It  is  neces- 
sary to  emphasize  here  the  fact  that  repression  is 
never  a  permanent  solution.  Take  for  example 
the  criminal  classes.  Just  so  long  as  the  criminal 
classes  and  the  police  are  arrayed  against  each 
other  as  enemies,  and  as  enemies  only ;  just  so  long 
as  one  is  the  hunted  and  the  other  the  hunter,  prog- 
ress is  impossible.  For  every  increase  in  efficiency 
of  the  criminal  the  police  will  develop  a  device  to 
circumvent  him,  and  correspondingly  every  increase 
in  efficiency  of  the  police  the  criminal  will  devise 
some  means  of  ''beating."  It  is  like  the  conflict 
between  the  penetrability  or  armour  and  the  pene- 
trating power  of  projectiles.  Every  increase  in  the 
effectiveness  of  one  is  balanced  by  a  correspond- 
ing increase  of  efficiency  in  the  other.  One  or 
the  other  party  to  the  conflict  may  temporarily  be 
in  the  ascendant  but  in  the  end  the  fight  is  a  draw 


316  MENTAL  HYGIENE 

and  can  never  be  decided  unless  the  level  of  the  con- 
flict can  be  transcended/*^ 

In  order  to  transcend  the  level  of  the  conflict  in 
dealing  with  the  socially  inadequate  classes  the 
problems  must  be  rescued  from  the  distortions  of 
emotionalism  either  in  the  form  of  hate  (moral  in- 
dignation) or  sentimentalism.  This  can  be  done  by 
dealing  with  the  whole  thing  on  the  level  of  scien- 
tific interest  (love)  which  will  be  able  to  see  the 
facts  in  their  real  settings  and  give  them  their  true 
values.  When  this  is  possible  all  sorts  of  ways  of 
helping  become  visible  and  problems  which  before 
seemed  insoluble  take  on  new  aspects.  This  is  the 
attitude  which  is  sorely  needed  with  respect  to  such 
problems  as  prostitution  and  until  it  can  be  attained 
they  will  wait  in  vain  for  anything  which  promises 
a  solution  or  if  not  a  solution  an  improvement  over 
present  conditions. 

It  is  to  this  end  that  I  have  used  the  term  social 
inadequacy  in  place  of  such  terms  as  the  depend- 
ent, defective,  and  delinquent  classes  because  it 
does  not  carry  any  suspicion  of  moral  delinquency 
or  moral  judgment  as  does,  for  example,  the  term 
delinquent.  This  is  perhaps  a  small  device  but  an 
important  one  for  after  all  * '  a  science  is  a  well  made 
language. ' ' 

To  see  man  as  a  social  animal  and  his  failures  as 
forms  of  social  inadequacy ;  to  approach  these  prob- 
lems free  from  prejudice  and  with  a  full  apprecia- 

10  For  a  discussion  of  the  resolution  of  the  conflict  see  "Mech- 
anisms of  Character  Formation." 


SUMMARY  317 

tion  that  in  each  instance  the  failure  has  back  of  it 
causes  adequate  to  explain  it;  then  to  attempt  to 
bring  to  bear  upon  the  problem  those  forces  which 
are  best  calculated  to  bring  about  results  which  are 
constructively  of  the  highest  value  to  both  the  in- 
dividual and  society;  and  then  to  be  able  to  apply 
the  principles  worked  out  in  dealing  with  individual 
cases  to  the  larger,  more  general  issues — these  are 
the  problems  of  Mental  Hygiene. 


INDEX 


Act  vs.  actor,  126,  127. 
Adjustment,   13. 
Adlerian  concept,   285. 
Admission  of  insane  to  hospitals, 

102. 
^sculapius,  1. 
After  care,  93. 
Age,      161;      anatomical,      162; 

chronological,    161;    old,    258; 

physiological,   162;   psychologi- 
cal,  162. 
Alcohol,    not    a    stimulant,    202; 

not  a  habit  forming  drug,  202 ; 

uses  of,  by  the  inebriate,  204, 

205. 
Animism,  40,   283. 
Animistic  level  of  culture,  18. 
Antagonism,   5 1 . 

Antipathic  emotions,  46,  51,  308. 
Asocial  individuals,  23. 
Auto-erotism,  282. 

Beers,  C.  L.,  68. 

Borderland      between       internal 
medicine  and  psychiatry,    106. 

Character  anomalies,  267. 
Character  traits,   270. 
Child  and  divorce,  236. 
Child,  only,  267. 
Compensation,  57. 
Complex,   incest,   281. 
Compromise,   57. 
Concepts,  underlying,  11. 


Conduct,  17,  21,  22,  64;  insane, 
65;  motives  for,  29;  at  the 
psychological   level,    26. 

Conflict,   38,  84. 

Conversion,  53,   231. 

Conversions,    hysterical,    54. 

Corpus  sanum  in  mente  sana,  x. 

County  system,   90. 

Courts,  juvenile,  137. 

Craziness,   67. 

Crime  vs.  criminal,  125,  127. 

Crimes,  arbitrary,  151. 

Criminal,  118;  the  concept,  118; 
conduct,  the  nature  of,  120; 
environment,  138;  vs.  insane, 
123;  insane,  treatment  of, 
155;  procedure,  152;  as  scape- 
goat, 131;  treated  as  individ- 
ual,  152. 

Criminals,  diseases  of,  143. 

Criminology,    148. 

Cures,  215. 

Death,  258,  260. 

Defence  mechanisms,  56;  reac- 
tions, 231. 

Development  of  individual  and 
society,   303. 

Disease,  xii;  as  maladaptation, 
ix. 

Dispensary,   92. 

District  attorney,  147,   148,  149. 

Divorce,  231. 

Dix,  Dorothea  L.,  68. 


319 


320 


INDEX 


Education,  31,  292. 

Edwards,  Jonathan,  descendants 
of,  173;  grandmother  of, 
173. 

Ellis,  Havelock,  235. 

Emotional  response,  305,  307, 
308. 

Emotions,  antipathic,  46,  51, 
308. 

Energy  transformations,  309. 

Environment  and  individual,  re- 
lations of,  13;  distinctions  be- 
tween, 18. 

Epilepsy,  the  term,  207;  mean- 
ing of,  207. 

Epileptics,  types  of,  206. 

Eugenics,  170,  182. 

Evolution,  social,  xi. 

Factory,   1,  2;   welfare  work,  3. 

Fads,  250. 

Failures  in  life,  v. 

Faith,  V. 

Family  romance,  43. 

Fatigue,  225. 

Fear,  67. 

Feeble-minded  not  just  children, 
165;  commitment  of,  187;  the 
concept,  159,  166;  education 
of,  188;  institution  care  of, 
186;  and  the  law,  189;  multi- 
plication of,  182;  segregation 
of,   187;  viability  of,   181. 

Feeble-mindedness,  causes  of, 
159;  menace  of,  180,  183; 
relative,  182,  184;  remedy  for, 
185. 

Fernald,  Walter  E.,  183. 

Frazer,  J.  G.,  132. 

Freudian  theory,  285. 

Gender,  279. 
Germ  plasm,  19. 
Gregariousness,  26. 


Hall,  G.  S.,  37. 

Hate,  122;  kind  of  conduct 
hated,   123. 

Hate  vs.  love,  44,  45. 

Health,  xi. 

Heredity,  52,  168. 

Homeless  unemployed,  212. 

Homosexuality,  209 ;  treatment 
of,  210. 

Hormone,   14. 

Hospital,  89;  general,  and  men- 
tal disease,  104,  106,  108; 
idea,  70;  municipal,  104; 
psychopathic,  92,  104;  State, 
91,  92. 

Hygeia,  1. 

Hysteria,  226. 

Idea,   16. 

Ideal  of  knowledge,  76,  81,  88. 

Identification,  51. 

Idleness,  255. 

Ignorance,  67,  224. 

Illegitimacy,  243;  expiation  and, 
244. 

Individual,  indistinctness  of  out- 
lines of,   19. 

Individual  and  environment,  re- 
lations of,  13;  distinctions  be- 
tween, 18. 

Individual  —  environment  rela- 
tion, 7,  19. 

Individualization,  95. 

Individual  —  society  disharmony, 
77. 

Individual  —  society  relation,  20. 

Inebriety,  201 ;   a  neurosis,  203. 

Insane,  60,  62;  conduct,  65; 
types  of  conduct,  63;  vs. 
criminal,  123;  and  hospitals, 
102;  in  Middle  Ages,  66;  per- 
son, 61 ;  the  word,  60. 

Insanity,   64. 

Instinct  vs.  reality,  39. 


INDEX 


321 


Instinct  for  the  familiar,  38,  39, 
40,  43,  44,  50,  52,  53,  54,  56, 
59,  128. 

Instinctive  conduct,  27,  28. 

Instincts,   socialization   of,   273. 

Integration,  13,  20;  levels  of,  26. 

Intelligence  measuring  scales, 
162,  163. 

Jelliffe,  S.  E.,  25. 
Jordan,  David  Starr,  164. 
Judge,  149;  vs.  prisoner,  141. 
Jury,   61;    verdict  of,    125,    126, 

129,   153. 
Justification,  57. 

Keller,  Helen,  24. 
Bandliness    in    treatment    of    in- 
sane, 71. 

Labour,  1,  2,  3. 

Law,    128;    statutory,    176,    177, 

178,  179,  180. 
Law  schools,   146. 
Laws,  5. 
Lever,   14. 
Libido,  285. 
Living    conditions,    improvement 

of,  6. 
Love,  313;  vs.  hate,  44,  45,  50. 

Maladjustment,  organic  basis 
of,  284. 

Man,  primitive,  274,  276,  301. 

Marriage,  232. 

Mens  sana  in  corpore  sano,  x, 
95. 

Mental  disorders,  30. 

Mental  element  in  disease,  112. 

Mental  hygiene,  vi,  7,  30;  move- 
ment, object  of,  32;  National 
Committee  for,  68,  94;  prob- 
lems of,  vi. 

Mental  mechanisms,  34. 


Mental  vs.  physical,  ix. 
Middleton,  George,  233. 
Milton,  235. 

Mind,    phenomena   of,    8;    struc- 
ture, x;   imsound,  61. 
Money,  value  of,  254. 
Mores,    135. 

Neurasthenia,  227. 
Neurons,  263. 
Nervous  system,  25. 
Non-restraint,   71. 
Nurses  for  insane,  70. 
Nutrition,  21. 

Occupations,  dangerous,  247;  di- 
ver sional,  115. 

Opinions,  instinctive,  28;  result 
of  experience,  28. 

Organ  inferiority,  285;  struc- 
ture, X. 

Osborn,  H.  F.,  301. 

Osborne,  T.  M.,  140,  141. 

Owen,  Robert,  3. 

Page,  69,  72. 

Past,  the  historical,  of  the 
psyche,  35. 

Patent  medicines,  215. 

Path  of  opposites,   44. 

Patient,  finding  the  "shut  in," 
100. 

Patient — institution  disharmony, 
77. 

Pauper,  192. 

Pauperism,  a  psychological  fail- 
ure, 194. 

Paupers,  types  of,  194. 

Philanthropy,  period  of,  in  care 
of  insane,  83. 

Physical  vs.  mental,  ix. 

Pinel,  68. 

Pithecanthropus,  29. 

Pleasure  motives,  281. 


322 


INDEX 


Pleasure  premium,  278,  280. 

Pleasure  seeking,  infantile,  281. 

Prejudice,  224. 

Preventive  medicine,  30. 

Primitive  community,  302. 

Primitive  man,  274,  276,  301. 

Prison  labour,  144. 

Prison  reform,  137. 

Prisoner  vs.  judge,  141. 

Prisoner,  rehabilitation  of,  140, 
143;  treatment  of,  129,  139. 

Projection,  46,  308. 

Prostitution,  195;  feeble-minded- 
ness  and,  195;  hate  and,  197; 
and  the  law,  199;  repression 
of,  196;  treatment  of,  by  in- 
dividualization, 200. 

Psyche  recapitulates  the  past, 
265. 

Psychiatrist  in  general  hospital, 
106. 

Psychiatry,  forensic,  110;  teach- 
ing of,  110,  114;  in  law 
schools,   147. 

Psychoanalysis,  263,  288;  is  edu- 
cational, 298. 

Psychogenic  disorders,  293,  294. 

Psychological  types  of  reaction, 
21. 

Psychopathic  wards,  104,  111; 
construction  of,  109. 

Psychoses,    of   prisoners,    139. 

Psychosis,  85. 

Psychotherapeutics,    115. 

Public  health,  5. 

Quakers,  69. 
Quarantine,  5. 

Race  preservation,  310. 

Rationalization,   57. 

Reaction  types,  1 1 ;  physical, 
11;  physico-chemical,  12; 
psychological,  13;  sensori- 
motor, 12;  social,  13. 


Readjustment,    36. 
Reality  vs.   instinct,  39. 
Reason,     relative     unimportance 

of,  for  everyday  conduct,  28. 
Reflex,  15. 
Reil,  68. 
Repression,    315. 
Responsibility,  127. 
Revenge,   136,   137. 

Safety  motive,  38,  39,  40,  43,  44, 
50,  52,  53,  54,  56,  59,  128. 

Salmon,  T.  W.,  181. 

Sanitation,  1 ;   objects  of,  3. 

Self-preservation,   310. 

Self -preservative   activities,    21. 

Sexuality,  275. 

Social  agencies,  93. 

Social  custom,  16. 

Social  diseases,  230. 

Social  hygiene,   245. 

Social  inadequacy,  stages  of,  311. 

Social  level,  failure  at,  23. 

Socially  inadequate,   23. 

Socially  inefficient  classes,  22. 

Social  psychology,  20. 

Social  reform,  2. 

Social  service,  93. 

Social  setting,  99. 

Society,  duty  of  individual  to, 
22;  healthy,  xii;   ill,  xiii. 

Speech,  free,  239. 

State  care,  89. 

Sterilization,  175,  184;  legisla- 
tion,   176. 

Structuralization,  x;  of  mind, 
xi. 

Sublimation,   278. 

Sympathy,  121. 

Trinil  race,  29. 
Trotter,  W.,  28. 

Unconscious,  27,  29,  34. 
Unconscious     motives     for     con- 
duct, 291;  wishes,  38. 


INDEX 


323 


Vagrant    class,    composition    of, 

211. 
Vocational    psychology,    249. 
Vocational  training,  31. 

Wealth,  253. 


Welfare    of    individual    and    so- 
ciety, 315. 
Will  to  power,  38. 
Woman  movement,  237. 
Worker,  welfare  of,  4. 


FEINTED    IN    THE    UNITED    STATES    01"    AMERICA 


THE  following  pages  contain  advertisements  of  books 
by  the  same  author  or  on  kindred  subjects. 


Mechanisms  of  Character  Formation 

By  WILLIAM  A.  WHITE,  M.D. 

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In  this  work,  the  author  has  endeavoured  to  found  the  principles 
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The  Interpretation  of  Dreams 

By  professor  SIGMUND  FREUD,  M.D.,  LL.D. 

Formerly  Professor  of  Nervous  and  Mental  Diseases  in  the  University 

of  Vienna 

Translated  by  A.  A.  BRILL,  Ph.B.,  M.D. 

Chief  of  the  Neurological  Department  Bronx  Hospital  and  Dispen- 
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Psychopathology  of  Everyday  Life 

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found genius  of  the  author  which  guides  ever  farther  into 
those  unexplored  depths  to  which  he  has  given  us  the  open- 
ing key." —  Journal  of  Nervous  and  Mental  Disease. 

"  The  book  is  as  entertaining  as  it  is  useful,  and  will  be 
valuable  not  only  to  the  physician  and  professional  psycholo- 
gist, but  to  pastors,  parents  and  social  workers." — Boston 
Transcript. 


THE  MACMILLAN  COMPANY 

Publishers   64-66  Fifth  Avenue    New  Yorls 


THREE  IMPORTANT  BOOKS  BY 

HENRY  H.  GODDARD 

Director  of  the  Research  Laboratory  of  the  Training  School  at  Vine- 
land,  N.  J.,  for  Feeble-Minded  Girls  and  Boys 

r  eeble-lVlincledneSS:  Its  Quses  and  Consequences 

Cloth,  8vo,  5P9  pages,  $4.50 
It  diflfers  from  most  of  those  in  the  field  in  that  it  is  what  may  be 
termed  a  source  study.  Instead  of  generalizing  on  the  subject  of 
feeble-mindedness,  presenting  arguments  for  this  theory  and  that  and 
concluding  with  vague  speculations,  Dr.  Goddard  gives  facts.  The 
book  is  so  comprehensive  in  scope  and  the  cases  exhibit  such  a  variety 
of  disorders  that  not  infrequently  will  the  parent,  the  teacher,  and  all 
who  have  to  do  with  incorrigible,  delinquent,  or  unfortunate  children 
encounter  characteristics  similar  to  those  displayed  by  the  subjects 
discussed  by  Dr.  Goddard.  This  work,  therefore,  contains  a  thorough 
consideration  of  this  vital  subject  which  was  so  interestingly  pre- 
sented, in  the  case  of  a  single  family,  in  the  author's  former  book, 
"The  Kallikak  Family." 


The  Kallikak  Family 


A  Study  in  the  Hekedity  of  Feeble-Mindedness 

Cloth,  8vo,  $1.60 

"No  more  striking  example  of  the  supreme  force  of  heredity  could 
be  desired." — The  Dial. 

"The  most  illuminating  and  complete  of  all  the  studies  in  heredity 
that  have  ever  been  made,  with  the  view  of  showing  the  descent  of 
mental  deficiency." — Bulletin  of  the  Medical  and  Chirurgical  Faculty 
of  Maryland. 

"This  is  the  most  convincing  of  the  sociological  studies  brought  out 
by  the  eugenics  movement." — The  Independent. 

"Dr.  Goddard  has  made  a  'find' ;  and  he  has  also  had  the  training 
which  enables  him  to  utilize  his  discovery  to  the  utmost." — American 
Journal  of  Psychology. 


The  Criminal  Imbecile 


Illustrated,  Cloth,  i2mo,  $1.60 
This  is  an  analysis  of  three  murder  cases,  in  which  the  Binet  tests 
were  used,  accepted  in  court  and  the  accused  adjudged  imbeciles  in 
the  legal  sense  (scientifically,  morons).  Three  types  of  defectives  are 
illustrated  in  the  three  cases.  Responsibility  is  discussed.  The  book 
is  important  to  all  practitioners  in  psychiatry,  students  of  feeble-mind- 
edness and  social  problems,  and  to  criminal  lawyers. 

THE  MACMILLAN  COMPANY 

Publishers     64-66  Fifth  Avenue     New  York 


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